A 33-year-old woman with a 5 cm submucosal fibroid (FIGO Type 2) undergoes hysteroscopic myomectomy. The myoma extends >50% into the myometrium and the procedure cannot complete full resection in one session. Which is the recommended next step?
- A Immediate conversion to laparotomy and hysterectomy
- B Stop the procedure, administer GnRH agonist for 6 to 8 weeks, and schedule a second-stage hysteroscopic myomectomy ✓
- C Proceed to uterine artery embolisation immediately
- D Leave the residual in situ and observe with annual ultrasound
Correct answer: B. Stop the procedure, administer GnRH agonist for 6 to 8 weeks, and schedule a second-stage hysteroscopic myomectomy
Explanation
For large FIGO Type 2 submucosal fibroids (>50% intramural extension), single-stage hysteroscopic resection risks fluid overload and incomplete removal. The recommended approach is to halt, give GnRH agonist for 6 to 8 weeks to shrink the fibroid and restore intracavitary protrusion, then perform second-stage hysteroscopic resection. This reduces complications and improves complete resection rates.
Reference: Te Linde's Operative Gynecology, 12th ed.
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