This video demonstrates hysteroscopic resection of a small, predominantly intramural focal adenomyoma in a patient with infertility and two previous failed IVF attempts.

Initial diagnostic hysteroscopy reveals only subtle abnormalities, including focal endometrial irregularity, increased vascularity and a minimal cavity bulge corresponding to the ultrasound findings.

The surgeon reduces intrauterine distension pressure to improve localization of the lesion, which does not protrude significantly because of its intramural position.

Hysteroscopic scissors are used to circumferentially incise and progressively separate the adenomyoma from the surrounding myometrium, encouraging it to project into the cavity.

An 18 Fr bipolar resectoscope is subsequently introduced to remove the mobilized lesion using controlled, gentle cutting movements.

The surgeon differentiates residual adenomyotic tissue from normal myometrium by their appearance, emphasizing the importance of avoiding excessive deep resection and uterine perforation.

The procedure concludes with near-complete macroscopic removal of the lesion, specimen retrieval and histopathological confirmation of adenomyoma, allowing the patient to proceed with further fertility treatment.