OBJECTIVE To introduce a new double-lumen intracervical cannula designed to allow a single-step hysteroscopic myomectomy with nonfragmented complete fibroid extraction after cold enucleation of submucosal type 2 fibroids, avoiding complications related to the use of energy and hypo-osmolar solutions. DESIGN Video article depicting the use of a new double-lumen intracervical cannula for single-step hysteroscopic cold myomectomy, according to our institutional care guidelines and after obtaining the patient's informed consent. (The publication of this video has been authorized by the Institutional Ethics Committee of CES University in Medellín, Colombia.) SETTING(S): Private infertility clinic. PATIENT(S) A 45-year-old woman with abnormal uterine bleeding consisting of polymenorrhea and hypermenorrhea, nonresponsive to medical treatment, caused by three type 2 (FIGO leiomyoma subclassification system) submucosal fibroids of 17, 15, and 13 mm with more than 80% of intramyometrial component. INTERVENTION(S) Hysteroscopic enucleation of three submucosal fibroids performed by blunt dissection using the 30° Bettocchi hysteroscope's bevel under continuous observation of the avascular subcapsular plane of the fibroids. Once full enucleation was attained, cervical dilatation to 12 mm with Hegar plugs was performed followed by intracervical placement of a newly designed double-lumen intracervical cannula that allows the concomitant introduction of the Bettocchi diagnostic hysteroscope and a 5-mm laparoscopic tenaculum into the uterine cavity for complete nonfragmented fibroid extraction under direct visualization. MAIN OUTCOME MEASURE(S) Complete and unfragmented fibroid extraction in a single intervention, absence of surgical complications, and postoperative course. RESULT(S) Ambulatory hysteroscopic myomectomy of three submucosal type 2 fibroids was successfully performed by blunt enucleation and complete nonfragmented fibroid extraction using the double-lumen intracervical cannula. The total operative time was 32 minutes, and the total amount of distension media (normal saline) used was 800 mL with a liquid balance of 50 mL. No surgical or anesthesia-related complications occurred. In the postsurgical evaluation, the patient classified her pain as minimal, giving it a score of 1 on a pain scale of 1 to 5 (in which 1 is the lowest and 5 the highest pain perception). When asked about the level of satisfaction with the surgical procedure, the patient reported the highest degree of satisfaction with a score of 5 on a satisfaction scale of 1 to 5 (in which 1 is the lowest and 5 the highest satisfaction). The patient reported having postsurgical regular menstrual cycles every 28 days and 3 bleeding days without hypermenorrhea. CONCLUSION(S) An efficient hysteroscopic myomectomy of submucosal type 2 fibroids with deep intramyometrial component can be performed with complete and nonfragmented fibroid extraction in a single intervention by using a newly designed double-lumen intracervical cannula. This technique allows the completion of the surgery without the need of a resectoscope, electrosurgery, or hypo-osmolar uterine distension media, thus avoiding potential complications such as thermal-induced myometrial injury and hyponatremia; a second surgical intervention will not be required because the fibroid enucleation is complete. The procedure can be performed with the use of a diagnostic hysteroscope that is widely available in gynecologic practices. (Acknowledgment: The authors thank Dr. David Olive for the invaluable help and guidance with this surgical technique and video article.).

中文翻译：

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宫腔镜下子宫肌瘤切除术采用冷摘除技术和双腔宫颈内套管完整提取肌瘤

目的 引入一种新的双腔宫颈内插管，旨在允许在冷摘除 2 型黏膜下肌瘤后进行单步宫腔镜子宫肌瘤切除术和非碎片完整肌瘤切除术，避免与使用能量和低渗溶液相关的并发症。设计视频文章描述了根据我们的机构护理指南并在获得患者知情同意后，使用新型双腔宫颈内插管进行单步宫腔镜冷子宫肌瘤切除术。（该视频的发布已获得哥伦比亚麦德林 CES 大学机构伦理委员会的授权。） 设置（S）：私人不孕症诊所。患者 (S) 一名 45 岁女性，子宫异常出血，包括月经过多和月经过多，对药物治疗无反应，由三个 2 型（FIGO 平滑肌瘤亚分类系统）黏膜下肌瘤引起，分别为 17、15 和 13 毫米，肌层内成分超过 80%。干预(S) 在连续观察肌瘤的无血管囊下平面的情况下，使用 30° Bettocchi 宫腔镜斜面钝性解剖对三个粘膜下肌瘤进行宫腔镜摘除术。完全摘除后，使用 Hegar 栓将宫颈扩张至 12 毫米，然后在宫颈内放置新设计的双腔宫颈内插管，允许同时将 Bettocchi 诊断性宫腔镜和 5 毫米腹腔镜持钩插入子宫腔用于直接可视化下完整的非碎片化肌瘤提取。主要结果测量（S） 在一次干预中完全和未碎裂的肌瘤提取，没有手术并发症，术后病程。结果（S）使用双腔宫颈内插管通过钝性摘除和完整的非碎片化肌瘤提取成功地对三个粘膜下层 2 型肌瘤进行了动态宫腔镜子宫肌瘤切除术。总手术时间为32分钟，使用的膨胀介质（生理盐水）总量为800毫升，液体平衡为50毫升。没有发生手术或麻醉相关并发症。在术后评估中，患者将她的疼痛归类为轻微，在 1 到 5 的疼痛量表上给它打 1 分（其中 1 是最低的疼痛感，5 是最高的疼痛感）。当被问及对手术过程的满意度时，患者报告的满意度最高，在 1 到 5 的满意度量表中得分为 5（其中 1 是最低的，5 是最高的满意度）。患者报告术后每 28 天和 3 天有规律的月经周期，没有月经过多。结论(S) 通过使用新设计的双腔宫颈内插管，可以在一次干预中通过完整和非碎片化的肌瘤提取，对具有深层肌层内成分的 2 型黏膜下肌瘤进行有效的宫腔镜下肌瘤切除术。这种技术允许在不需要电切镜、电外科或低渗子宫扩张介质的情况下完成手术，从而避免潜在的并发症，如热致子宫肌层损伤和低钠血症；由于肌瘤摘除术已完成，因此不需要第二次手术干预。可以使用在妇科实践中广泛使用的诊断性宫腔镜来执行该程序。（致谢：作者感谢 David Olive 博士对这项手术技术和视频文章的宝贵帮助和指导。）。