Spontaneous Pregnancy After the Removal of Long-Term Retained Laminaria.

We report the case of a woman with laminaria retention up to six years, followed by spontaneous pregnancy after the removal by hysteroscope of the intrauterine retained laminaria. A 26-year-old woman (G1P0) visited our hospital with complaints of prolonged menstrual bleeding, dyspareunia, and infertility. She had a history of dilatation and evacuation (D&E) at nine weeks of gestation six years earlier. A transvaginal ultrasound showed an artifact, and hysteroscopy revealed a long foreign body, which was suspected to be a laminaria retained after the prior abortion. In the hysteroscopic surgical procedure, the laminaria was cut, and the two halves were excised using resectoscope electrodes and hooked to the electrodes for removal. Thereafter, a year later, she conceived spontaneously and gave birth to a baby by cesarean delivery due to the arrest of labor progress. We are the first to present a pregnant case after the removal of a six-year retained laminaria.

The suture fixation of levonorgestrel-releasing intrauterine device in the treatment of adenomyosis: A case report.

INTRODUCTION: The report on Levonorgestrel⁃releasing intrauterine system (LNG⁃IUS) suture under hysteroscopy is very rare, and currently only three articles have been reported. We reported a patient with adenomyosis who had previously had LNG-IUS, but the LNG-IUS moved downward. We sutured and fixed the LNG-IUS under hysteroscopy. CASE PRESENTATION: A 42-year-old woman presented with a 7-year history of adenomyosis of the uterus and adenomyoma adenomyosis. Half a year ago, due to increased menstrual flow, LNG-IUS was placed in the uterine cavity, and the treatment effect was satisfactory. Nine days ago, vaginal bleeding occurred, and ultrasound showed that LNG-IUS had moved downward. We performed LNG-IUS suturing under hysteroscopy for her, and a half-year follow-up ultrasound showed that the position of LNG-IUS was normal. CLINICAL DISCUSSION: For adenomyosis, LNG-IUS is the most promising medical therapy due to its ability to suppress hormones to improve symptoms with a low profile of adverse effects while enabling women to maintain fertility. However, the high excretion rate of LNG-IUS may cause patients with adenomyosis to lose confidence in continuing to use this treatment method. CONCLUSION: Our case report demonstrated the feasibility and effectiveness of LNG-IUS suture fixation under hysteroscopy. It provided another reliable treatment option for those patients with adenomyosis for whom the LNG-IUS fell off or fell down.

Importance of abdominal X-ray to confirm the position of levonorgestrel-releasing intrauterine system: A case report.

BACKGROUND: Levonorgestrel-releasing intrauterine systems (LNG-IUSs) gradually release levonorgestrel into the uterus and is effective against hypermenorrhoea and dysmenorrhea. Complications associated with the insertion include expulsion, displacement, and uterine perforation. Ultrasonic identification of copper intrauterine devices (IUDs) is possible due to echogenicity from the copper coils. However, the barium sulfate coatings of LNG-IUSs do not always provide hyperechoic images. Both barium sulfate and copper are radiopaque and clearly identifiable on X-ray. Thus, X-ray imaging is required to locate LNG-IUSs. CASE SUMMARY: A 46-year-old woman with hypermenorrhoea due to submucosal myomas was treated with LNG-IUS at another hospital. Three LNG-IUS insertions had apparently been followed by spontaneous expulsion, although objective confirmation using imaging was not performed. The patient was referred to our institution for surgery. At the first visit, there appeared to be no device in the uterus, and none was observed on transvaginal ultrasound. However, two LNG-IUSs were observed in the pelvis on abdominal plain X-rays prior to surgery. Hysteroscopic myomectomy was performed, and the two LNG-IUSs were found to have perforated the myometrium. The devices were safely removed during surgery, and the submucosal myomas were also removed. The perforated section of the myometrium was minimal+ADs- therefore, a repair operation was not required.CONCLUSIONPlain abdominal X-rays facilitate the determination of whether an LNG-IUS is in the uterine cavity. Therefore, it is important to confirm a device's location, regardless of whether spontaneous expulsion is suspected, prior to inserting another device.

The role of hysteroscopy in reproductive surgery: Today and tomorrow.

During the last decades, the number of couples with reproductive issues has substantially increased. Many different factors are implicated in reproductive failure, including uterine factors. Endometrial pathologies, such as endometrial polyps, hyperplasia, endometritis, and Mullerian anomalies, can also hinder embryo implantation. Hysteroscopy remains the gold standard for the evaluation and treatment of intrauterine pathology. Over the last few years, advances in hysteroscopic instrumentations and surgical techniques have significantly evolved, the refinement in technology, miniaturization of instruments, and improved image quality have rendered hysteroscopy a more patient and user-friendly procedure that has enhanced its use in reproductive medicine. Nowadays, hysteroscopy is essential in the evaluation and treatment of women with infertility. This article underscores the major technological breakthroughs achieved over the last few years with emphasis on the role of artificial intelligence, augmented reality, and 3D hysteroscopy, which can set new benchmarks in hysteroscopy applied to reproductive medicine.

Complete uterine septum involving cervix with unilateral external cervical os stenosis: diagnosis and management.

BACKGROUND: Congenital external cervical os stenosis is a form of Mullerian duct abnormality which is rare in virginal adolescents. CASE: Pre-operatively, two non-sexually active adolescents of 12 and 14 years of age, with history of light menses and severe lower abdominal pain for 2 and 4 months respectively, were diagnosed with an obstructed, oblique vaginal septum syndrome. However, at operative vaginoscopy, a single cervix with a duplicated cervical os and unilateral cervical stenosis was discovered, confirming the diagnosis of a complete uterine septum involving the cervix and unilateral cervical stenosis. They were treated by expanding the affected external cervical os while leaving the hymen intact. A year following the treatment, follow up results found no recurrence of symptoms. SUMMARY AND CONCLUSION: Operative vaginoscopy using a hysteroscope is crucial and recommended for the diagnosis and treatment of congenital external cervical os stenosis in virginal adolescents.

Novel Use of Hysteroscopy in the Assessment of Tubal Patency in Difficult Cannulation.

The objective was to assess the method of chromopertubation (CPT) in cases of difficult cannulation to minimize the false-negative cases of tubal block. We had performed laparoscopy and hysteroscopy in 66 females as infertility workup. In all these females, cannulation through the cervical canal was difficult and tubal patency test showed tubal block with Leech-Wilkinson cannula. Then, through the inlet of hysteroscope, methylene blue dye was injected and the patency of tubes was assessed again. In 59 out of the 66 females, we observed that when cannulation and dilation of cervix was difficult, then CPT with hysteroscope showed positive tubal patency test. Introduction of hysteroscope with visualization bypasses cervical factor and reduces false-negative results of tubal patency that is an added advantage of hysteroscope that has not been reported earlier.

Herlyn-Werner-Wunderlich syndrome and its complications: A report of two cases and literature review.

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital malformation characterized by uterus didelphys, unilateral blind hemivagina, and ipsilateral renal agenesis. The obstructed vagina affects menstrual flow, leading to related clinical symptoms after menarche. However, the age of onset, initial symptoms, and clinical complications differ among patients owing to the different types of vaginal septum. Herein, we report 2 cases. The first case is of a 20-year-old woman who presented with fever; she was diagnosed with vaginitis and pelvic inflammation due to the vaginal septum with ostiole. The second case is of a 12-year-old girl who complained of abdominal pain; she was diagnosed as having pelvic inflammation, omentitis, and suppurative appendicitis due to the atretic vaginal septum.

A sandwich technique for the removal of stone embedded intrauterine devices in the urinary bladder.

A urinary bladder stone in young adults is uncommon. Dislocation of an IUD to adjection organs is a rare condition. We present a case of a 28-year female with a chief complaint of right side pelvis discomfort, off and on with the urinary system. In this case, we performed cystoscopy assisted laser lithotripsy, hysteroscopy to localize and remove IUD, transurethral resectoscope for removing IUD residual, and resection sinus tract. This article's objective states that the multidisciplinary approach to removing dislocated IUD is safe and effective and raises awareness of forgotten contraceptive devices and their potential complications.

An innovative method of retrieval of the broken suction cannula tip during medical termination of pregnancy using a fibrobronchoscope during the coronavirus disease 2019 pandemic.

The breaking of the tip of the 'Karman cannula' inside the uterine cavity while performing suction curettage for missed abortion is an extremely rare phenomenon. Ideally, such foreign bodies should be removed using a hysteroscope under direct vision. In the absence of a hysteroscope, retrieval may be attempted using retrieving forceps either under ultrasonographic guidance or blindly. A 26-year-old female patient presented as a case of missed abortion at 6 weeks of gestation and underwent suction and evacuation. The tip of the cannula broke during the procedure. Multiple attempts were made to retrieve the cannula tip using forceps under ultrasound guidance without success. The patient was planned to be shifted to a higher centre as the hysteroscope was not available at this centre. However, owing to travel restrictions and lockdown imposed for the coronavirus disease 2019 (COVID 2019) pandemic, the patient could not be transferred. An innovative method using the fibre optic bronchoscope was devised by the otorhinolaryngologist and gynaecologist, and the retained impacted cannula was safely removed from the left uterine cornu under vision.

Rare Pediatric Vaginal Granular Cell Tumor: A Case Report.

BACKGROUND: Granular cell tumors (GCTs) are usually benign and occur primarily in the trunk and head. Vaginal tumors are rare, particularly in children. CASE: A 9-year-old girl was admitted with irregular vaginal bleeding for 1 year. The bleeding had worsened in the previous 1 month. B-ultrasound and computed tomography showed a round mass in the vagina. We performed vaginoscopy using a hysteroscopic exploration and tumor resection via an open technique. The pathology of the resected tumor confirmed a vaginal wall GCT. No recurrence was noted in the following 16 months. SUMMARY AND CONCLUSION: To our knowledge, our prepubescent girl is the youngest patient with GCT in the literature. Histopathological evaluation and complete tumor resection with clear margins is the primary treatment for benign or malignant GCTs.

Four Surgical Strategies for the Treatment of Cesarean Scar Defect: A Systematic Review and Network Meta-analysis.

OBJECTIVE: This network meta-analysis compared treatment via laparoscopy, hysteroscopy (HP), combined laparoscopy with HP (LH), and vaginal repair (VR) for reducing intermittent abnormal uterine bleeding and cesarean scar defect (CSD) diverticulum depth in patients with CSD. DATA SOURCES: Electronic databases (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials, MEDLINE, ClinicalTrials.gov, Chinese Biomedical Literature Database, and China National Knowledge Integrated) were searched for articles published through June 13, 2018. METHODS OF STUDY SELECTION: The search included randomized controlled trials (RCTs) and observational studies of surgical treatment for CSD. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were reported. RCTs were evaluated by the Cochrane risk-of-bias tool, observational studies by Risk of Bias in Nonrandomized Studies of Intervention, and overall evidence quality by grade. Data were analyzed by STATA (version 15.0; StataCorp, College Station, TX) and R software for windows (version 3.5.0; R Core Team, 2018). TABULATION, INTEGRATION, AND RESULTS: Ten studies (n = 858; 4 RCTs and 6 observational studies) were included. Patients who underwent uterine diverticulum resection by LH had a shorter duration of abnormal uterine bleeding than those by HP (SMD = 1.36, 95% CI, 0.37-2.36; p = .007) and VR (SMD = 1.58, 95% CI, 0.97-2.19; p <.0001). LH reduced the CSD diverticulum depth more than VR (SMD = 1.57, 95% CI, 0.54-2.61; p = .003). There was no significant difference in efficacy among the surgical procedures. CONCLUSION: LH reduced intermittent abnormal uterine bleeding and scar depth more than the other surgical interventions. Larger clinical trials are warranted to verify this analysis.

Carbon dioxide in office diagnostic hysteroscopy: An open question. A multicenter randomized trial on 1982 procedures.

OBJECTIVE: to compare carbon dioxide and saline solution distension in diagnostic hysteroscopies with regards to patient discomfort and procedural time and in accordance with the instrument diameter (5 mm vs 3.5 mm). The secondary outcome was to evaluate the role of the patient age and the obstetrical history on perception of pain and procedural time. STUDY DESIGN: This is a prospective multicenter randomized study including 1982 patients that underwent office diagnostic hysteroscopy in: Policlinico Abano Terme, Università Cattolica del Sacro Cuore in Rome and Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli" in Acquaviva delle Fonti. They were firstly randomized according to distension medium and secondly according to instrument diameter. Pain perception after the procedure was assessed by VAS (Visual Analogue Scale) score and procedural time was registered. Mann-Whitney U test was used to compare data. RESULTS: Lower pain score and procedural time were recorded with the employment of Carbon Dioxide (p < 001). Patient discomfort and procedural time were significantly influenced by the instrument diameter independent of the distension medium used, though in the subgroup where gas was employed VAS score after 1 min (VAS1) resulted lower compared to saline solution in both the traditional and mini-hysteroscopy procedures (p < 001). CONCLUSION: Carbon dioxide and saline solution are both suitable distension media for outpatient diagnostic hysteroscopy; nonetheless, carbon dioxide confers advantages in terms of pain perception and procedural time.

Clinical Progress in Negative-Pressure Endometrial Sampler for Endometrial Cancer Screening / 中国医科大学学报

Endometrial cancer is a common malignancy of the female reproductive system. Despite improvement in living standards, the incidence of endometrial cancer is increasing due to the lack of effective screening. Early detection of endometrial cancer and precancerous lesions can significantly improve prognosis and survival. At present, China lacks a method for screening endometrial lesions comparable to that for cervical cancer screening. A recently introduced endometrial sampler has the advantages of simple operation, low cost, and minimal trauma, and is gradually being accepted for clinical screening of endometrial cancer and precancerous lesions in other countries.This study aims to explore current screening methods for endometrial cancer and precancerous lesions and the clinical application of an endometrial sampler for screening.

Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps.

OBJECTIVE: To find out the clinical effects of post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps in terms of clinical outcome and the expression of endometrial Vascular Endothelial Growth Factor (VEGF). METHODS: Ninety-eight patients who were confirmed as endometrial polyp in the hospital from April 2014 and December 2016 were selected and divided into treatment group and a control group using random number table, 49 in each group. Patients in both groups were given hysteroscopic operation. Patients in the treatment group were treated by progesterone hormone drugs after hysteroscopic operation, while patients in the control group were not given progesterone hormone. The changes of menstrual blood volume, menstrual cycle and expression of VEGF were compared between the two groups after treatment, and the recurrence condition, thickness of endometrium and hemoglobin were followed up one year after treatment. RESULTS: The pictorial blood loss assessment chart (PBAC) scores of patients in the two groups had no significant difference before treatment (P>0.05); but the score of the treatment group was much lower than that of the control group. The improvement rate of menstrual cycle of the treatment group was much higher than that of the control group, and the difference had statistical significance (P<0.05). Compared to before treatment, the serum VEGF level of the patients in both groups had a remarkable decline in the 1st, 3rd and 6th month after treatment, and the difference had statistical significance (P<0.05). The difference of the serum VEGF level between the two groups in the 1st and 3rd month after treatment had no statistical significance (P>0.05). The serum VEGF level of the treatment group was notably lower than that of the control group six months after treatment, and the difference had statistical significance (P<0.05). The follow-up results demonstrated that the treatment group had smaller thickness of endometrium and higher level of hemoglobin compared to the control group, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05). CONCLUSION: Post hysteroscopic progesterone hormone therapy has favorable clinical effect in treating endometrial polyps as it can effectively prevent the recurrence of endometrial polyps, relieve the level of hemoglobin and reduce endometrial thickness.

Uterine Sounding: Is There a Difference between Blind and Hysteroscopically Directed Measurements?

STUDY OBJECTIVE: To evaluate the accuracy of traditional blind uterine sounding in measuring uterine cavity length (UCL), compared with measurement by hysteroscopic guidance. DESIGN: A cross-sectional descriptive study (Canadian Task Force classification III). SETTING: Academic multispecialty medical center. PATIENTS: Fifty-eight women undergoing elective hysteroscopic procedures. INTERVENTION: UCL measurement. MEASUREMENTS: UCL measurements were obtained by the traditional blind sounding technique and by hysteroscopically directed measurement. Hysteroscopic measurements were assumed to represent true uterine cavity length. Differences between the 2 measurements were calculated to analyze error and bias. RESULTS: Mean UCL for blind sounding and hysteroscopically directed measurements were 80.81 mm and 86.55 mm, respectively. The magnitude of error between measurements was >10 mm in 36.2% of cases, with underestimation of true UCL in 55.17% of cases. CONCLUSION: True UCL is underestimated by blind sounding, and the frequency, magnitude, and direction of error may be greater than are clinically acceptable.

Hysteroscopic excision of symptomatic myometrial adenomyosis: feasibility and effectiveness.

OBJECTIVE: To explore the feasibility and efficacy of hysteroscopic excision of myometrial adenomyotic lesions. DESIGN: A case-series study. SETTING: A university medical centre. POPULATION: 51 women with myometrial adenomyosis completed the study. METHODS: The patients underwent hysteroscopic excision of myometrial adenomyosis and were followed up for 24 months. The degree of symptoms, uterine volume, and serum CA125 concentrations were recorded. The degrees of menorrhagia and dysmenorrhea were evaluated. RESULTS: The mean MVJ and VAS score significantly decreased from the baseline. The uterine volume and the serum CA125 significantly reduced. CONCLUSIONS: Hysteroscopic excision of myometrial adenomyotic lesions is feasible and may be effective in improving symptoms. TWEETABLE ABSTRACT: Hysteroscopic excision is feasible for patients with symptomatic adenomyosisis.

Phloroglucinol and Misoprostol for cervix pretreatment before diagnostic hysteroscopy:a meta-analysis of randomized controlled trials / 中国内镜杂志

Objective To determine the efficiency and safety of Phloroglucinol and Misoprostol for cervix pretreat-ment before diagnostic hysteroscopy. Methods Trials were located through electronic searches of the PubMed, MED-LINE, Springer, CNKI, VIP, CBM, WanFang Data (from the date of establishment of the databases to June 2015). Bibliographies of the retrieved articles were also checked. Result A total of 18 trials involving 2 341 patients were included. The Meta-analysis showed: application of Phloroglucinol lenovo better open and dilate the cervix [O? =2.95, 95 % CI (1.96, 4.45), = 0.000]; To better clarity of the operative field [ O? = 9.50, 95 % CI (6.46, 13.98), = 0.000]; To better shorten the operation time [O? =-4.12, 95 % CI (-5.75,-2.49), =0.000];To bet-ter able to reduce the amount of intraoperative leakage [ O? =0.22, 95%CI (0.10, 0.49), = 0.0002]; and postop-erative adverse reactions should be significantly lower than Misoprostol [ O? = 0.01, 95 % CI (0.00, 0.04), =0.000]. The difference was statistically significant. Conclusions Phloroglucinol is more effective and safer than Miso-prostol in inducing proper cervical priming and may be the optimal choice for cervical pretreatment before diagnostic hysteroscopy.

Analysis of the curative effect and safety of uterine artery embolization combined with hysteroscope in treating cesarean scar pregnancy / 中国内镜杂志

Objective To explore the curative effect and safety of uterine artery embolization combined with hysteroscope in treating cesarean scar pregnancy. Methods 36 cesarean scar pregnancy patients (CSP diameter under six cm by ultrasound) from June 2014 to June 2015 were selected and studied. All patients received the UAE and arterial injection of Methotrexate (MTX), and while the blood beta-HCG fell to around 1 000 u/L and the lesions thickness to serous membrane were over 0.2 cm by ultrasound, pregnancy lesions were resected by hysteroscopy surgery. Results The UAE and arterial injection of Methotrexate about (20.12 ± 3.85) min. Blood beta-HCG level and lesion diameter both fell or decreased, each with [(17 902.74±11 818.23) u/L vs (12 842.73 ± 8 525.73) u/L and (3.65 ± 1.02) cm vs (3.12 ± 0.97) cm] (t = 8.58, P < 0.01, t = 2.26, P < 0.05). Hysteroscopy surgery cost about (19.13 ± 2.67) min, the amount of bleeding were (17.43 ± 7.28) ml. Postoperative blood beta-HCG decreased to (113.45 ± 36.14) u/L within 2~4 days, the patients were discharged. Conclusion Hysteroscopy surgery with pretreatment of UAE combined with MTX injection could gain satisfactory outcome for patients with CSP. It has high success rate, low blood loss, fewer adverse reactions satisfactory outcome.

Use of hysteroscope for vaginoscopy or hysteroscopy in adolescents for the diagnosis and therapeutic management of gynecologic disorders: a systematic review.

STUDY OBJECTIVE: The purpose of this article is to review the published literature and perform a systematic review to evaluate the effectiveness and feasibility of the use of a hysteroscope for vaginoscopy or hysteroscopy in diagnosing and establishing therapeutic management of adolescent patients with gynecologic problems. DESIGN: A systematic review. SETTING: PubMed, Web of science, and Scopus searches were performed for the period up to September 2013 to identify all the eligible studies. Additional relevant articles were identified using citations within these publications. PARTICIPANTS: Female adolescents aged 10 to 18 years. RESULTS: A total of 19 studies were included in the systematic review. We identified 19 case reports that described the application of a hysteroscope as treatment modality for some gynecologic conditions or diseases in adolescents. No original study was found matching the age of this specific population. CONCLUSIONS: A hysteroscope is a useful substitute for vaginoscopy or hysteroscopy for the exploration of the immature genital tract and may help in the diagnosis and treatment of gynecologic disorders in adolescent patients with an intact hymen, limited vaginal access, or a narrow vagina.

Hysteroscopic morcellation: review of the manufacturer and user facility device experience (MAUDE) database.

STUDY OBJECTIVE: To investigate the number and type of adverse events associated with hysteroscopic morcellation of intrauterine disease. DESIGN: Systematic review of Manufacturer and User Device Experience (MAUDE) database from 2005 to June 2014 (Canadian Task Force classification III). SETTING N/A PATIENTS: Women undergoing hysteroscopic surgery for removal of intrauterine polyps or myomas with use of a reciprocating morcellator. INTERVENTIONS: The MAUDE database was searched for the key words "Hysteroscope," "Hysteroscopic reciprocating morcellator," "Interlace," "MyoSure," "Smith & Nephew," and "TRUCLEAR," to identify reported incidences of device malfunction, injury, or death. A total of 119 adverse events were analyzed. Reports were reviewed individually and categorized by date of occurrence, type of morcellation device, type of complication, and a brief description. Each company was contacted to provide an estimate of the number of procedures performed or units sold to date. MEASUREMENTS AND MAIN RESULTS: From 2005 to June 2014, 119 adverse events were reported to the MAUDE database. On the basis of severity, adverse events were categorized as major or minor complications. Major events included intubation/admission to an intensive care unit (n = 14), bowel damage (n = 12), hysterectomy (n = 6), and death (n = 2). Minor events included uterine perforation requiring no other treatment (n = 29), device failure (n = 25), uncomplicated fluid overload (n = 19), postoperative bleeding controlled using noninvasive measures (n = 6), and pelvic infection (n = 4). These events were then categorized according to manufacturer. The number of adverse events reported to the MAUDE database was divided by the total units sold as a surrogate for the estimated number of procedures performed. Understanding the limitation of the numbers used as a numerator and denominator, we concluded that adverse events complicated hysteroscopic morcellation in <0.1% cases. CONCLUSIONS: The suction-based, mechanical energy, rotating tubular cutting system was developed to overcome adverse events that occur during traditional resectoscopy. On the basis of acknowledged limited information from the MAUDE database, it seems that life-threatening complications such as fluid overload, uterine perforation, and bleeding do occur with hysteroscopic morcellation but less frequently than with traditional electrocautery.