A novel hysteroscopic myomectomy strategy based on RoBEEM (Roller ball Enucleation followed by Excision Method): Integration of adjunctive techniques to expand TCR indications.

OBJECTIVE: To evaluate the clinical efficacy and safety of a novel hysteroscopic myomectomy technique, RoBEEM (Roller ball Enucleation followed by Excision Method), developed to expand the indications of transcervical resection of myomas (TCR). DESIGN: Retrospective consecutive case series. SETTING: Uterine Myoma Endoscopic Surgery Center, Sano Hospital, Hyogo, Japan. PARTICIPANTS: A total of 631 TCR procedures were performed in 613 patients between January 2016 and December 2024 for submucosal myomas ≥ 4 cm in diameter or with a resected weight ≥ 35 g. INTERVENTIONS: RoBEEM integrates myoma pseudocapsule dissection with a roller ball electrode and centripetal cutting with a loop electrode. Supporting techniques include SSCI (Single-Sheath Continuous Irrigation), thumbing, and sequential slice removal. MAIN OUTCOME MEASURES: Complete resection rate, resection efficiency (g/min), intraoperative complications, and postoperative outcomes. RESULTS: One-stage complete resection was achieved in 576 of 631 procedures (91.2%). The median myoma diameter was 5.2 cm; resection efficiency was 1.1 g/min and significantly higher for large myomas. Among 53 FIGO type 3 cases, 47 achieved one-stage complete resection (88.7%). No perforations occurred during dissection with the roller ball. Fifteen patients reported pregnancy, of whom eight delivered. CONCLUSION: RoBEEM achieved a high rate of single-session complete resection for large or complex submucosal myomas. These findings indicate that RoBEEM can broaden the practical applicability of hysteroscopic myomectomy, allowing appropriately selected patients who would otherwise undergo more invasive surgery to be managed hysteroscopically.