Transcervical Intralesional Vasopressin Injection in Hysteroscopic Myomectomy—Description of a New Technique

Abstract

An original technique of transcervical intralesional vasopressin injection that allowed direct infiltration to submucous myomas under hysteroscopic control is described. Five patients with a symptomatic submucous myoma 1.5-5 cm in size scheduled for hysteroscopic myomectomy were recruited. The time required for vasopressin injection was less than 3 minutes in all cases. The time required for myomectomy ranged from 3 to 32 minutes. Four cases had no fluid absorption, whereas 1 had absorption of 1000 mL. The patient with the longest operative time and fluid absorption had multiple submucous myomas, including a large G2 myoma of 5 cm. All cases had complete excision without complication. The surgeons rated the operations as having minimal bleeding and excellent clarity. Transcervical intralesional vasopressin injection is a potentially simple, quick, and feasible method to facilitate complete resection of submucous myomas in hysteroscopic myomectomy.

Slice and Excise Technique in Hysterscopic Myomectomy for Large G0 Submucous Myoma

“…In addition, using transvaginal radiofrequency myolysis with or without hysteroscopy was tried [25]. Moreover, intralesional vasopressin injection was also described [26]. Modified technique in which the base was excised followed by ring forceps extraction after misopristol priming [27].…”

Optimal Dose of Pituitrin in Laparoscopic Uterine Myomectomy: a Prospective, Double-Blinded, Randomized Controlled Trial

“…Hemostasis was evaluated by surgeons during the operation with methods described elsewhere 11,12 . Briefly, a visual score on the visual clarity (VS, 0-10,0: worst visual clarity; 10: optimal visual clarity) of surgical field was given by the surgeon.…”

“…In parts of the world where synthetic vasopressin is not available, pituitrin, a bovine posterior pituitary extract containing vasopressin and oxytocin, is used 6,7 . Vasopressin and oxytocin, however, have various effects on hemodynamics [9][10][11][12][13][14]. The optimal dose to achieve satisfactory view with minimal hemodynamic effects have not been documented.…”

The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

“…Using a lower perfusing pressure, say at 40 mmHg instead of the usual 90–100 mmHg, may allow a slight bulge of the adenomyoma into the cavity to be visualized. Vasopressin, a potent vasoconstrictor, may be injected into the uterus by using an oocyte retrieval needle [ 89 ] to result in contraction of the uterus and reduce bleeding. Afterwards the endometrium and the myometrium overlying the adenomyoma can be incised using a cutting loop or needle or dissected with the use of a pair of scissors, following which the adenomyoma is removed by the cutting loop or a pair of grasping forceps coupled with twisting actions, separating it from the underlying myometrium.…”