Background
Intrauterine hysteroscopic morcellators have been studied as an alternative method for removing submucosal leiomyomas.

Aims
To assess the long‐term efficacy of hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding (AUB).

Materials and Methods
We conducted a prospective cohort study including all women with AUB who underwent a hysteroscopic resection with mechanical morcellation of a benign submucosal leiomyoma confirmed at histopathology. Need for further surgery, patient satisfaction, symptom resolution and post‐operative complications were documented by direct patient contact after a minimum of six months of follow‐up.

Results
A total of 73 women were included in the study with a mean length of follow‐up of 32 ± 13 months. Mean total size of pathology at the time of index surgery was of 42 ± 20 mm. A total of 9/73 (12%) women required subsequent hysterectomy and 20/73 (27%) any subsequent related surgery (operative hysteroscopy, abdominal myomectomy or hysterectomy) with the estimated three‐year cumulative incidence being 30 ± 6%. Satisfaction rate of participants was 84%. In multivariate Cox proportional analyses, only a total size of pathology of 50 mm or more was found to be significantly associated with the risk of requiring further surgical procedures (hazard ratio = 2.9, P = 0.02).

Conclusions
Hysteroscopic morcellation of submucosal leiomyomas is an effective method to manage women with AUB, although women with larger pathology have an increased risk of requiring subsequent surgical procedures.