Direct injection of vasopressin during hysteroscopic myomectomy: a case report.

Background: Hysteroscopic myomectomy is the ideal procedure for symptomatic women with submucosalfibroids 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 ofa dilute vasopressin through the operative port decreased intraoperaftve 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.