Laparoscopic Removal of a Retroperitoneal Hysteroscopic Microinsert Using Fluoroscopy

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Reproductive Health

Background:

• Hysteroscopic microinsert placement for permanent sterilization has a perforation risk of 0.9%–2.6%.
• Perforation typically leads to intraperitoneal device migration, necessitating surgical intervention.
• Standard retrieval procedures often involve laparoscopy or laparotomy.

Observation:

• A case of hysteroscopic microinsert perforation occurred during permanent sterilization.
• The microinsert migrated to the retroperitoneal space, an unusual location for device displacement.
• This retroperitoneal migration was identified during diagnostic laparoscopy.

Findings:

• This is the first reported case of a hysteroscopic microinsert perforating and migrating to the retroperitoneal space.
• Laparoscopic retrieval of the retroperitoneal microinsert was successfully performed.
• Real-time fluoroscopy was crucial for guiding the laparoscopic removal of the device.

Implications:

• Highlights the potential for rare but serious complications with hysteroscopic sterilization.
• Suggests the need for awareness of potential retroperitoneal migration following hysteroscopic procedures.
• Emphasizes the utility of intraoperative imaging, such as fluoroscopy, in managing device malposition during laparoscopic surgery.