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Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps.
J Minim Invasive Gynecol. 2018 May - Jun; 25(4):583-584.JM

Abstract

STUDY OBJECTIVE

To demonstrate step-by-step the technique of hysteroscopic adhesiolysis (HA) by means of a blunt spreading technique using double-action forceps to dissect and restore the layer between the anterior and posterior uterine walls in a patient with severe intrauterine adhesions (IUAs), particularly in cases in which the endometrial lining is obscured on ultrasound imaging and the endometrial cavity is completely occluded on hysteroscopy.

DESIGN

A step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III).

SETTING

A university-affiliated hospital.

PATIENT

A 36-year-old, gravida 3, para 1, abortus 2 woman presenting with amenorrhea for 5 months after surgical termination of a 53-day intrauterine pregnancy. She had no cyclic lower abdominal pain. Ultrasound revealed an obscure endometrial stripe and no obvious hematometra. Both the urine human chorionic gonadotropin test and the progesterone withdrawal test were negative. One month before admission, hysteroscopic adhesiolysis failed because the uterine cavity was inaccessible because of adhesions completely occluding the lower uterine cavity. Additionally, the uterine cavity could not be explored with a probe because the anatomic layer of the endometrial lining could not be easily identified by transabdominal ultrasound.

INTERVENTION

HA using a blunt spreading dissection technique with double-action forceps to restore the uterine cavity followed by "ploughing" of the intrauterine scar tissue using cold scissors [1].

MEASUREMENTS AND MAIN RESULTS

An intraoperative technique with commentary highlighting tips for a successful dissection. The uterine cavity was successfully restored using the blunt spreading dissection technique. There were no complications, including false uterine wall passage, uterine perforation, or fluid overload. Postoperative hysteroscopy at 1 month revealed an almost normal uterine cavity.

CONCLUSIONS

HA using a blunt spreading dissection technique to restore the uterine cavity is a simple, effective, and safe hysteroscopic skill, especially when the endometrial stripe is obscured on ultrasound imaging and exploring the uterine cavity by means of a probe has failed. Furthermore, this technique may serve as an alternative to resectoscopic techniques because it uses cold forceps and scissors, which provide better protection for the endometrium.

Authors+Show Affiliations

Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.Department of Obstetrics, Gynecology, Baylor College of Medicine, Houston, Texas.Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China.Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China. Electronic address: forxudabao@126.com.Department of Obstetrics, Gynecology, Baylor College of Medicine, Houston, Texas.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Video-Audio Media

Language

eng

PubMed ID

29038040

Citation

Huang, Huan, et al. "Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps." Journal of Minimally Invasive Gynecology, vol. 25, no. 4, 2018, pp. 583-584.
Huang H, Cheng C, Johnson G, et al. Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps. J Minim Invasive Gynecol. 2018;25(4):583-584.
Huang, H., Cheng, C., Johnson, G., Wang, R., Xue, M., Zhang, A., Xu, D., & Guan, X. (2018). Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps. Journal of Minimally Invasive Gynecology, 25(4), 583-584. https://doi.org/10.1016/j.jmig.2017.10.011
Huang H, et al. Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps. J Minim Invasive Gynecol. 2018 May - Jun;25(4):583-584. PubMed PMID: 29038040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hysteroscopic Intrauterine Adhesiolysis Using a Blunt Spreading Dissection Technique With Double-action Forceps. AU - Huang,Huan, AU - Cheng,Chunxia, AU - Johnson,Grace, AU - Wang,Ruoyi, AU - Xue,Min, AU - Zhang,Aiqian, AU - Xu,Dabao, AU - Guan,Xiaoming, Y1 - 2017/10/13/ PY - 2017/09/08/received PY - 2017/10/01/revised PY - 2017/10/06/accepted PY - 2017/10/19/pubmed PY - 2019/5/21/medline PY - 2017/10/18/entrez KW - Complications KW - Hysteroscopic adhesiolysis KW - Intrauterine adhesion KW - Surgical skills SP - 583 EP - 584 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 25 IS - 4 N2 - STUDY OBJECTIVE: To demonstrate step-by-step the technique of hysteroscopic adhesiolysis (HA) by means of a blunt spreading technique using double-action forceps to dissect and restore the layer between the anterior and posterior uterine walls in a patient with severe intrauterine adhesions (IUAs), particularly in cases in which the endometrial lining is obscured on ultrasound imaging and the endometrial cavity is completely occluded on hysteroscopy. DESIGN: A step-by-step explanation of the technique using videos and pictures (educative video) (Canadian Task Force Classification III). SETTING: A university-affiliated hospital. PATIENT: A 36-year-old, gravida 3, para 1, abortus 2 woman presenting with amenorrhea for 5 months after surgical termination of a 53-day intrauterine pregnancy. She had no cyclic lower abdominal pain. Ultrasound revealed an obscure endometrial stripe and no obvious hematometra. Both the urine human chorionic gonadotropin test and the progesterone withdrawal test were negative. One month before admission, hysteroscopic adhesiolysis failed because the uterine cavity was inaccessible because of adhesions completely occluding the lower uterine cavity. Additionally, the uterine cavity could not be explored with a probe because the anatomic layer of the endometrial lining could not be easily identified by transabdominal ultrasound. INTERVENTION: HA using a blunt spreading dissection technique with double-action forceps to restore the uterine cavity followed by "ploughing" of the intrauterine scar tissue using cold scissors [1]. MEASUREMENTS AND MAIN RESULTS: An intraoperative technique with commentary highlighting tips for a successful dissection. The uterine cavity was successfully restored using the blunt spreading dissection technique. There were no complications, including false uterine wall passage, uterine perforation, or fluid overload. Postoperative hysteroscopy at 1 month revealed an almost normal uterine cavity. CONCLUSIONS: HA using a blunt spreading dissection technique to restore the uterine cavity is a simple, effective, and safe hysteroscopic skill, especially when the endometrial stripe is obscured on ultrasound imaging and exploring the uterine cavity by means of a probe has failed. Furthermore, this technique may serve as an alternative to resectoscopic techniques because it uses cold forceps and scissors, which provide better protection for the endometrium. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/29038040/Hysteroscopic_Intrauterine_Adhesiolysis_Using_a_Blunt_Spreading_Dissection_Technique_With_Double_action_Forceps_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(17)31235-9 DB - PRIME DP - Unbound Medicine ER -