The availability of hysteroscopic tissue morcellation systems that are effective, disposable and relatively safer compared to the conventional resectoscopes has revolutionised the management of sub mucosal fibroids. These morcellators have gained rapid acceptance, and have been widely embraced around the world and particularly in Australia.
The ability to remove the resected chips from the operative field allows the operator to morcellate rapidly even voluminous myoma of limited access. This modern armamentarium has changed the game and can be considered as the “New surgery”. However, the resection of type 1 and type 2 sub mucosal fibroids, especially in the fundal and cornual position remains a challenge, and the use of conventional equipment may still be required. The conventional “Old Surgery” could nevertheless become a dying art, due to the rapid uptake of the morcellation systems, which may deskill the operators, and prevent the trainees to be exposed to complex resections.
This presentation will address some of these issues in terms of surgical training, procedural effectiveness, and complications.
A review of the modern techniques using the conventional equipment (cold loop dissection, bipolar radiofrequency needles, interposition of anti adhesions, ultrasound mapping and perioperative guidance) will hopefully convince the audience that the Old and the New should not be opposed, but in fact taught conjointly. A special emphasis will be put on techniques bridging the “Old and the New” like the combination of bipolar conventional resection with miniature equipment and the use of tissue removal systems.