Hysteroscopic myomectomy currently represents the standard minimally invasive surgical procedure for treating submucous fibroids, with abnormal uterine bleeding and reproductive issues being the most common indications. While hysteroscopic myomectomy has been shown to be safe and effective in the control of menstrual disorders, its effects on infertility remain unclear. The review provides a comprehensive survey of all hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2). MEDLINE and EMBASE searches identified published papers from 1970. The choice of the technique mostly depends on the intramural extension of the fibroid, as well as on personal experience and available equipment. 'Resectoscopic slicing' still represents the 'gold standard' technique for treating fibroids G0, even if several other effective techniques including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy have been proposed. On the other hand, the present review clearly indicates that there is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. Most techniques aim at the transformation of an intramural fibroid into a totally intracavitary lesion, thus avoiding a deep cut into the myometrium. At present, the 'cold loop' technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium.

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Uterine cancer is the most common type of gynecological neoplasm. Conventionally, the standard treatment for early-stage endometrial cancer is surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. However, this leads to definitive sterilization in reproductive-age women. We report a rare case of a young woman with endometrioid endometrial adenocarcinoma successfully treated with reproductive preservation therapy in order to preserve her uterus. Pretreatment evaluation including tumor grade, depth of myometrial invasion, tumor size, and hormone-receptor status indicated a favorable prognosis. The patient was treated with hysteroscopic resection of the endometrial cancer, of the endometrium near lesion, and of the myometrium under lesion plus hormone therapy. Thirty months after operative hysteroscopy, the patient has given birth by cesarean section at 39 weeks of gestation to a male child of 3.2 kg and is now completely free of disease. We therefore conclude that there may be a role for effective treatment of endometrioid carcinomas with preservation of reproductive capacity, even if our preliminary result should be validated by a longer follow-up.

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The grading, the size of the myomas and the age of patients play a crucial role in completing the hysteroscopic myomectomy in a single step. Only the diameter greater than 3 cm in G2 myomas is correlated to a higher risk of a multiple procedure.

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