Intrauterine device extraction through laparoscopic hysterotomy

Abstract

Case report

A 52-year-old woman with an intrauterine device placed more than 10 years before consulted our department after a failed attempt to its removal in the outpatient area. While performing the colposcopy a completely fibrosed cervical canal permitted no access to the uterine cavity. The IUD was confirmed to still be placed intrauterine by pelvix x-ray and an endovaginal sonography. Due the risk for future infections, a device extraction was recommended, although the patient categorically refused a hysteroscopic approach as an hysterectomy. After discussing all available options the patient agreed on a laparoscopic approach with uterine conservation. It was performed through a vertical hysterotomy with the electrocautery hook and the incision closed using intracorporeal vycril stitches. The patient was dismissed 48 h after surgery. A sonographic control was carried 6 months later revealing no evidence of scar complication.

Discussion

Hysteroscopy with or without sonographic intraoperative control to avoid uterine perforation, remains the recommended treatment in case of retained IUD. Difficult cases with a fibrotic cervix can be dilated with a scalpel under general anaesthesia before hysteroscopy to retrieve the coil. Laparoscopic approach is usually being used as a minimally invasive procedure for the extraction of IUD that are misplaced or migrate to the peritoneal cavity. In very seleted cases, laparoscopy can be a useful tool in case other approaches are ineffective or rejected by the patient.

摘要

病例报道：52岁女性, 10余年前放置宫内节育器（IUD）, 在门诊试图取出IUD失败后, 于我科咨询。在进行阴道镜检查时, 完全纤维化的宫颈管使得无法进入宫腔。盆腔X光和阴道内超声检查证实IUD仍放置在宫内。考虑到未来感染的风险, 尽管患者断然拒绝宫腔镜手术和子宫切除术, 但还是建议取出IUD。在讨论了所有可供选择的方案后, 患者同意采用腹腔镜手术并保留子宫。采用电灼钩垂直子宫切开术, 并采用可吸收的缝线缝合切口。患者在手术后48小时出院。6个月后进行超声检查, 无瘢痕并发症。

讨论：宫腔镜检查加或不加术中超声以避免子宫穿孔, 仍然是保留的IUD的推荐治疗方法。宫颈纤维化的疑难病例可以在宫腔镜检查前用手术刀在全身麻醉下扩张宫颈。腹腔镜手术通常是一种微创手术, 用于取出错位或移位到腹膜腔的IUD。在非常特殊的情况下, 如果其他方法无效或被患者拒绝, 腹腔镜检查可能是一个有用的工具。

Keywords:

• Intrauterine device
• hysterotomy
• laparoscopy

Disclosure statement

The authors declare no conflict of interest in the development of this document.