April 8th, 2020

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Title:
Direct Injection of Vasopressin During Hysteroscopic Myomectomy: A Case Report
Authors:  M. Brigid Holloran-Schwartz, M.D., Kallie Harrison, M.D., and Richard Gimpelson, M.D.
 
BACKGROUND: Hysteroscopic myomectomy is the ideal procedure for symptomatic women with submucosal fibroids who desire to preserve their fertility. Vascular myomas can limit visualization when a mechanical morcellator is used. Injection of a dilute vasopressin solution has been shown to decrease blood loss during laparoscopic myomectomy. To date, direct injection of a dilute vasopressin during hysteroscopic myomectomy has not been described.

CASE: Our first patient\'s hysteroscopic myomectomy of a vascular submucosal myoma had to be terminated before complete resection due to impaired visualization and maximum fluid overload. During a subsequent patient\'s procedure, direct injection of a dilute vasopressin through the operative port decreased intraoperative bleeding and enabled complete resection.

CONCLUSION: Injecting a dilute vasopressin solution directly into a vascular submucosal myoma during hysteroscopic resection can assist with hemostasis and visualization, enabling complete resection.
Keywords:  hysteroscopic myomectomy, laparoscopic myomectomy, mechanical morcellator, myomectomy, myometrium, submucosal fibroid, submucosal myoma, uterine leiomyoma, vasopressin
   
   
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