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At present conventional bipolar resectoscopy is widely recognized as first choice procedure for major hysteroscopic operations [1, 2]. We have proposed an alternative approach to operative hysteroscopy called IBS® Integrated Bigatti Shaver [3] that improving the visualization during the procedure, as the tissue chips are removed from the uterine cavity at the same time of resection, reduces several problems of conventional resectoscopy such as fluid overload and water intoxication with a lower risk of uterine perforation. In cooperation with Karl Storz GmbH & Co., we have created a new shaving system that, introduced through a straight operative channel of a panoramic 90° optic, allows performing all kinds of major hysteroscopic operations. We have recently published the first randomized comparative study [4], designed in order to compare 50 cases performed with conventional bipolar resectoscope with 50 cases performed with the IBS®. All kinds of major intrauterine pathologies such as polyps up to 6 cm and G0, G1 and G2 sub-mucosal myomas, classified according to the ESGE guidelines, up to 3 cm in diameter were included in the study [5]. Dilatation time, global time of the procedure, resection time and fluid balance were carefully monitorized during each procedure of the two groups of patients.  The result of this study confirmed the several advantages offered by the IBS® such as better visualization during the procedure as tissue chips were removed at the same time of resection, no coagulation or cutting current was needed, utilization of normal saline and a much faster learning curve. In addition the 24 Fr total diameter of the optic allows a dilatation of the cervix up to number 8.5 of Hegar reducing the risk of cervical laceration and uterine perforation.  We could approach all kind of polyps and myomas up to 3 cm in a very fast, precise and clean way. The only drawback of this technique was represented by myomas with higher consistency and with a diameter larger than 3 cm. For this reason we have designed two new blades, number 6 which has a flute beak shape and number 7 which resemble the shark jaws in order to be more aggressive in cutting the fibrotic tissue. We report this interesting case in which the IBS® was able to remove in a two-step procedure a very large cervical G2 submucosal myoma, considered one of the most difficult cases to approach by conventional resectoscopy.

A 4-cm G2 cervical submucosal myoma removed with the IBS® Integrated Bigatti Shaver