Hysteroscopic myomectomy, the primary treatment for submucous fibroids, has traditionally been performed under general anesthesia. However, advances in smaller hysteroscopic instruments now allow this procedure to be done in the outpatient setting without cervical dilation for small fibroids (less than 1.5-2 cm). Procedural sedation and analgesia is increasingly used in gynecologic surgery, but has been associated with higher rates of incompleteness relative to general anesthesia. The efficacy and safety of procedural sedation and analgesia for hysteroscopic myomectomy have not been thoroughly evaluated in a trial setting. In this issue, Julia F. van der Meulen and team report a randomized controlled trial investigating whether procedural sedation and analgesia is noninferior to general anesthesia in patients with fibroids undergoing hysteroscopic myomectomy. Although noninferiority was not shown, there were no significant differences in clinical outcomes or quality of life measures, suggesting that the procedure might be safely performed under procedural sedation and analgesia in the outpatient setting. The results provide valuable insight for clinicians counseling women undergoing this procedure.

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