Hysteroscopic morcellator to overcome cervical stenosis

Abstract

Objective: To report a step-by-step technique to using a hysteroscopic morcellator to safely gain access into the intrauterine cavity in two patients with severe cervical stenosis and concomitant intrauterine pathology.

Design: Video article introducing the hysteroscopic morcellator for overcoming severe cervical stenosis.

Setting: Academic-based practice.

Patient(s): A 36-year-old G0 female with primary infertility and uterine polyps and a 34-year-old G0 female with uterine polyps and a difficult trial transfer before undergoing an IVF cycle. In both patients, preoperative saline-infused sonography revealed submucosal filling defects and severe cervical stenosis.

Intervention(s): A hysteroscopic technique using the Hologic Myosure to overcome severe cervical stenosis with or without the use of intraoperative ultrasound.

Main outcome measure(s): Despite using preoperative Cytotec, cervical stenosis was identified. Under direct visualization, a 4-mm Myosure XL blade was placed through a 7.25-mm Myosure XL hysteroscopy. The cutter blade, powered by an electromechanical drive system, enables simultaneous rotation and reciprocation. The blade allows one to shave and remove tissue and is applied to cervical stenosis, allowing safe access into the intrauterine cavity.

Result(s): The intrauterine hysteroscopic Myosure morcellator allowed for safe and direct entry into the uterine cavity. We have since applied this technique to all patients where cervical stenosis is identified and have minimized potential uterine perforation and false tracks in our patients.

Conclusion(s): Our technique is an alternative method for overcoming severe cervical stenosis and minimizing potential intraoperative complications.

Keywords: Cervical stenosis; challenging cervix; hysteroscopy; intraoperative ultrasound; morcellation.