Chapter-08 Hysteroscopic Morcellation

BOOK TITLE: ISARCON 2017 Manual of Operative Hysteroscopy

1. Manchanda Rahul
2. Bhave Priya
3. Tyagi Stuti
4. Meena Jahanavi
Publishing Year
Author Affiliations
1. New Delhi, India, Dr Manchanda’s Clinic, New Delhi, India, Dr. Manchanda’s Clinic, 7 Ring Road, Lajpat Nagar IV, New Delhi, New Delhi, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Manchanda’s Endoscopic Center, New Delhi; Pushpawati Singhania Research Institute, New Delhi, India, PSRI Multispeciality Hospital, New Delhi, India
2. Bansal Hospital, Bhopal, Madhya Pradesh, India
Chapter keywords
Submucous leiomyoma, hysteroscopic surgical technique, hysteroscopic morcellation, resectoscopy, TRUCLEARTM hysteroscopic morcellator, MyoSure® tissue removal system


Endometrial polyps and submucous myomas represent a common gynecologic problem that may cause abnormal uterine bleeding or subfertility, and are amenable to hysteroscopic removal. Submucous leiomyomas are the most difficult type of fibroid which have been associated with abnormal uterine bleeding, infertility and other clinical issues. The diagnosis and management of submucous leiomyomas is particularly important in cases of infertility, as these types of myomas appear to have the greatest impact on pregnancy and implantation rates. Although traditional hysteroscopic resection with a loop electrode has been a reliable tool for the gynecologic surgeon, its use typically requires a large diameter hysteroscope (7–9 mm outer diameter), hypotonic distension media, and a well-anesthetized patient. Further, the loop resectoscopy process invariably produces vision-obscuring tissue chips and introduces a significant risk for uterine perforation. Conversely, hysteroscopic morcellation allows for the use of smaller diameter hysteroscopes that require less cervical dilation and less anesthesia without sacrificing procedure time. The amount of tissue removed per minute will only be a function of how much contact the cutting window maintains with the myoma and how quickly the device can cut tissue and aspirate it out.

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