Hysteroscopic Intrauterine Adhesiolysis Using the "Ploughing" Technique With Cold Scissors

Abstract

Study objective: The majority of the current published literature describes hysteroscopic adhesiolysis (HA) for patients with intrauterine adhesions (IUA) using electrical instruments which may cause thermal injury to the endometrium. This video shows the procedure for HA using the "ploughing" technique with cold scissors.

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

Setting: Third Xiangya Hospital of Central South University, Changsha, China.

Patient: A 39-year-old woman diagnosed with IUA.

Intervention: HA using the ploughing technique with cold scissors, followed by adjunct postoperative treatment with a follow up hysteroscopy 2 months later.

Measurement and main results: The uterine cavity was successfully reopened, and the scars covering the inner uterine walls were ploughed longitudinally to release the contraction imposed by the scars, as well as to provide a fresh and rich blood-supplied surface for endometrium to grow and cover after the surgery. There were no complications. The follow-up hysteroscopy 2 months later revealed a normal uterine cavity and much improved endometrium, along with restoration of almost normal menses.

Conclusion: HA using the ploughing technique with cold scissors is effective for rebuilding the uterine cavity even for patients with severe IUA. Its advantages merit further study.

Keywords: Hysteroscopy; Intrauterine adhesiolysis; Intrauterine adhesions; Postoperative management; Thermal injury.