Stepwise REsectoscopic DIscoid SHaping (REDISH) Followed by Ultrasound-guided Forceps Traction for Safe and Effective One-step Removal of Large and Deep Submucous Myomas

Objective: To evaluate the safety and effectiveness of a novel technique for the resectoscopic removal of FIGO types 0 to 3 myomas, termed REsectoscopic DIscoid SHaping (REDISH). Design: Retrospective study. Setting: University Hospital. Participants: Patients with a single FIGO type 0 to 3 myoma undergoing resectoscopic myomectomy. Interventions: Resectoscopic myomectomies using the REDISH technique (Group A) were compared with those performed using cold loop-assisted resectoscopic myomectomy (Group B). REDISH involves bilateral and symmetrical resection of the myoma intracavitary portion under direct hysteroscopic visualization using a monopolar loop to obtain a disc-shaped remnant. Owing to its flat surfaces, the disc can be securely grasped with ring forceps and subjected to gentle traction under transabdominal ultrasound guidance. This traction facilitates detachment of the intramural portion from the pseudocapsule, promoting extrusion into the uterine cavity. The extruded tissue is then further resected hysteroscopically, and the cycle of traction followed by resection can be repeated until complete removal is achieved. In the comparator group, the intramural component was mechanically enucleated with a nonenergized loop before electrosurgical resection. Outcomes included percentages of one-step procedures, complications, surgical time, and reproductive outcomes. Results: A one-step procedure was performed in 97.9% of REDISH cases versus 87.1% with the cold loop technique (P < .001). No major complications occurred in either group. Operative time with REDISH was significantly shorter across all myoma types and sizes, with time savings increasing with myoma complexity (interaction analysis). Regression model showed that operative time increased by 3.60, 10.39, and 15.47 minutes for FIGO types 1, 2, and 3, respectively. Reproductive outcomes showed a higher ongoing pregnancy rate (63% vs 50.5%, P < .05), while no significant differences were observed in clinical pregnancy rate, miscarriage rate, or spontaneous delivery rate. Conclusions: The REDISH technique proved safe, effective, and faster than the cold loop-assisted technique, with the greatest benefits seen in myomas ≥4 cm and with >50% intramural extension. Notably, it may reduce the perforation risk by avoiding deep dissection into the pericapsular plane. Reproductive outcomes were also reassuring.