Type 2 myoma located in the fundus of the uterus is relatively harder to remove compared to the myoma located in the anterior or posterior wall. We described a technique using cold knife hysteroscopy system and Myosure® tissue removal suite. Myoma capsule was cut with a 3 mm scissor under direct hysteroscopy view. When the capsule is open, we use a 3 mm grasper to dissect, isolate and pull the myoma. After dilation of the cervix to Hega size of 20, A Lin’s grasper is used to hold the myoma and rotate it from the myometrium under abdominal ultrasound monitoring.

To reduce the volume of the myoma, we use a Myosure® tissue removal suite to morcellate the myoma. When the myoma size is reduced, we use Lin’s grasper to get the smaller myoma piece from the uterine cavity. A balloon was inserted into the uterine cavity to stop bleeding and prevent adhesion.