Intrauterine device extraction through laparoscopic hysterotomy.

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.