Iatrogenic orifice transluminal endoscopic surgery (IOTES): managing uterine perforations at operative hysteroscopy.

OBJECTIVE

To prove safety and feasibility of an intra-abdominal endoscopic evaluation via an iatrogenic uterine perforation that occurred during operative hysteroscopy.

DESIGN

Clinical case report.

SETTING

University Hospital.

PATIENT(S): A multimorbid woman with postmenopausal bleeding with iatrogenic uterine perforation during hysteroscopic resection of an endometrial polyp.

INTERVENTION(S): Intra-abdominal endoscopic evaluation via the iatrogenic uterine perforation site with use of a standard diagnostic hysteroscope.

MAIN OUTCOME MEASURE(S): Visibility, technical feasibility, clinical course, and hematologic follow-up of the patient.

RESULT(S): A sufficient assessment of the intra-abdominal cavity and the uterine defect was possible with use of a small-diameter diagnostic hysteroscope during the workup of an iatrogenic uterine perforation. No additional intervention-related side effects occurred.

CONCLUSION(S): This technique was safe and feasible to gain operative access to the abdominal cavity, allowing a complete diagnostic intra-abdominal inspection for lesions of the adjacent organs. IOTES bears the potential to become a time-saving low-risk alternative to diagnostic standard laparoscopy.