Fertility and sterility · 2026
Office Hysteroscopic Removal of an IUD-Myoma Composite Using an 18.5 Fr Hysteroscope and Blue Laser in a Postmenopausal Woman with Cervical Atrophy: A No-Anesthesia Approach.
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Li Congqing, Song Fei, Zhang Liwei, Sun Yingmei
Аннотация
OBJECTIVE: To study the feasibility and safety of office-based, no-anesthesia, no-dilation hysteroscopic removal of an intrauterine device (IUD)-myoma complex using a blue laser in a postmenopausal woman with severe cervical atrophy.
DESIGN: Step-by-step video demonstration of the surgical procedure with narrated explanation.
SUBJECTS: A 56-year-old postmenopausal woman (G2P2, menopause for 7 years) with a 30+ year indwelling T-shaped copper IUD. She had no postmenopausal bleeding or pelvic pain. Examination revealed severe cervical atrophy with marked stenosis. Transvaginal ultrasound (both 2D and 3D) showed the IUD encased by a myoma-like lesion, forming an IUD-myoma complex measuring approximately 2.5 cm × 2.0 cm × 1.8 cm. The patient declined inpatient surgery under anesthesia.
INTERVENTION: Office vaginoscopic hysteroscopy was performed without anesthesia or cervical dilation using an 18.5 Fr continuous-flow hysteroscope (5 Fr working channel). Normal saline was used as the distension medium at a pressure of 100 mmHg with continuous fluid circulation. A 450 nm blue laser (30 W, continuous mode) was introduced through the working channel to vaporize the myoma-like tissue in a stepwise manner. Once the IUD was fully exposed, 5 Fr grasping forceps were used to remove the IUD together with the remaining myoma tissue en bloc. After vaporization, residual tissue fragments were retrieved for histopathological examination.
MAIN OUTCOME MEASURES: Successful IUD removal, operative time, pain score (Visual Analog Scale, VAS 0-10), intraoperative and postoperative complications, and follow-up ultrasound findings at one week.
RESULTS: The procedure was successfully completed without conversion to general anesthesia or cervical dilation. Total operative time was 36 minutes. The patient tolerated the procedure well, reporting mild discomfort (VAS pain score 3/10). No intraoperative complications occurred. The patient experienced slight vaginal bleeding for 2 days postoperatively, which resolved spontaneously. At the one-week follow-up visit, transvaginal ultrasound revealed a normal uterine cavity with no residual IUD fragments or myoma tissue. Histopathological examination of the residual tissue fragments confirmed benign leiomyoma.
CONCLUSION: Office-based, no-anesthesia, no-dilation hysteroscopic removal of an IUD-myoma complex using a blue laser is feasible and safe in a postmenopausal woman with severe cervical atrophy. This technique offers a patient-centered alternative for women at high anesthesia risk or who prefer to avoid hospital admission. To our knowledge, this is the first report of using a blue laser for an IUD-myoma complex under such challenging conditions.
PATIENT CONSENT: The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.
DESIGN: Step-by-step video demonstration of the surgical procedure with narrated explanation.
SUBJECTS: A 56-year-old postmenopausal woman (G2P2, menopause for 7 years) with a 30+ year indwelling T-shaped copper IUD. She had no postmenopausal bleeding or pelvic pain. Examination revealed severe cervical atrophy with marked stenosis. Transvaginal ultrasound (both 2D and 3D) showed the IUD encased by a myoma-like lesion, forming an IUD-myoma complex measuring approximately 2.5 cm × 2.0 cm × 1.8 cm. The patient declined inpatient surgery under anesthesia.
INTERVENTION: Office vaginoscopic hysteroscopy was performed without anesthesia or cervical dilation using an 18.5 Fr continuous-flow hysteroscope (5 Fr working channel). Normal saline was used as the distension medium at a pressure of 100 mmHg with continuous fluid circulation. A 450 nm blue laser (30 W, continuous mode) was introduced through the working channel to vaporize the myoma-like tissue in a stepwise manner. Once the IUD was fully exposed, 5 Fr grasping forceps were used to remove the IUD together with the remaining myoma tissue en bloc. After vaporization, residual tissue fragments were retrieved for histopathological examination.
MAIN OUTCOME MEASURES: Successful IUD removal, operative time, pain score (Visual Analog Scale, VAS 0-10), intraoperative and postoperative complications, and follow-up ultrasound findings at one week.
RESULTS: The procedure was successfully completed without conversion to general anesthesia or cervical dilation. Total operative time was 36 minutes. The patient tolerated the procedure well, reporting mild discomfort (VAS pain score 3/10). No intraoperative complications occurred. The patient experienced slight vaginal bleeding for 2 days postoperatively, which resolved spontaneously. At the one-week follow-up visit, transvaginal ultrasound revealed a normal uterine cavity with no residual IUD fragments or myoma tissue. Histopathological examination of the residual tissue fragments confirmed benign leiomyoma.
CONCLUSION: Office-based, no-anesthesia, no-dilation hysteroscopic removal of an IUD-myoma complex using a blue laser is feasible and safe in a postmenopausal woman with severe cervical atrophy. This technique offers a patient-centered alternative for women at high anesthesia risk or who prefer to avoid hospital admission. To our knowledge, this is the first report of using a blue laser for an IUD-myoma complex under such challenging conditions.
PATIENT CONSENT: The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.