This video demonstrates Laparoscopic myomectomy instead of hysteroscopic myomectomy for large submucous fibroids. Laparotomy, laparoscopy, and hysteroscopy are the three main procedures employed by gynecologists to remove uterine fibroids. The abdominal approach (laparotomy and laparoscopy) is used to treat subserosal and intramural lesions, and the vaginal approach (hysteroscopy) is used for submucous fibroids. With the advent of hysteroscopic surgery, operative hysteroscopies can manage most intrauterine surgical problems with fast recovery. However, hysteroscopic myomectomy for large deeply intramural extension submucous fibroid has still been deemed a challenge for hysteroscopies. It involves issues of longer operating time, fluid overload, uterine perforation, and incomplete resection in one surgery. In conclusion, even hysteroscopic myomectomy offers several benefits to the patient. We must bear in mind that hysteroscopic removal of large deeply intramural invasion submucous fibroids is still a technically challenging procedure and might be associated with higher surgical morbidity and incidence of additional surgery. To avoid these tough situations, the vaginal approach should be shifted to the abdominal approach with laparoscopy, which can remove fibroids and still meet the principle of minimally invasive surgery; however, this particular approach should be performed only by those surgeons who are skilled in laparoscopic suturing.
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