Uterine leiomyomas or fibroids are common benign tumours of the uterus. Myomectomy is performed via laparoscopy, laparotomy or hysteroscopy depending on the location of the myoma, the size and the symptoms. Before myomectomy, the patient must be informed of the risk to undergo conversion of the surgical techniques as well as about myoma recurrence. Administration of a GnRH agonist for 4 months before myomectomy improves pre and postoperative haemoglobin levels and reduces the size of the myoma. In the case of submucosal myomas of FIGO type 0, 1 and 2, which are <4 cm in diameter, hysteroscopic myomectomy is the preferred approach and significantly improves pregnancy rates. The laparoscopic approach is feasible when the number of fibroids is low, and they have a small diameter.

The improvements in techniques, endoscopic instrumentation and surgical experience have completely changed the approach to uterine intracavitary pathologies, allowing the physician to achieve more reliable diagnostic and therapeutic results. The advent of these new technologies allows us today to improve advanced hysteroscopic surgery by increasing the efficacy of an operating room environment but avoiding the need for the inpatient setting for most of the procedures. It is possible to treat severe cervical stenosis or intrauterine synechiae, including Asherman’s syndrome, G2 myomas, congenital uterine malformations, adenomyosis and chronically retained products of conception in an ambulatory setting. The future looks to further the simplification of instrumentation, and establish a safer and easier delivery of energy sources.

This chapter provides a description of advanced hysteroscopic procedures and their benefits in modern gynaecological practice.