Strategies for Hysteroscopic Removal of the Deeply Embedded Intrauterine Device

Study Objective

The objectives of this video are to review key principles and techniques to facilitate hysteroscopic removal the deeply embedded intrauterine device (IUD) and to demonstrate the application of these strategies during three unique cases of deeply embedded IUDs.

Design

Educational video highlighting surgical techniques.

Setting

Academic medical center.

Patients or Participants

We present the following 3 cases of hysteroscopic removal of deeply embedded IUDs: 1) Fractured IUD arm embedded within the cervix, 2) IUD embedded at 3 points within the cervix in a patient with cervical stenosis, and 3) IUD embedded within the tubal ostium.

Interventions

We first present the following strategies to set yourself up for success during cases of deeply embedded IUDs: vasopressin injection, cervical dilation with a beveled scope rather than dilators, and use of a pressure bag rather than a fluid management system. We then highlight a variety of surgical techniques that facilitated IUD removal during the 3 patient cases, including the “push and spread” technique with hysteroscopic scissors, rotating the light cord to optimize the position of the scissors, nudging the IUD with the scissors to assess progress with dissection, switching to a smaller hysteroscope in cases of cervical stenosis, using a hysteroscopic morcellator in cases of cervical stenosis, rotational movements with hysteroscopic graspers, and using a Kelly clamp for a stronger grasp on the IUD.

Measurements and Primary Results

N/A

Conclusion

We have demonstrated a variety of key principles and innovative techniques for hysteroscopic removal of the deeply embedded IUD. Each patient case presented unique challenges that required patience, persistence, and creativity.