Intrauterine Devices Deeply Embedded within the Myometrium: Video-Based Description of Surgical Management and...

To describe the management of two cases of intrauterine devices (IUDs) deeply embedded within the myometrium, illustrating the surgical techniques used and the rationale for combined approaches.

Tertiary referral hospital.

Two patients referred after recent IUD placement with pelvic pain and abnormal uterine bleeding.

In the first case, 2D/3D ultrasound revealed an IUD deeply embedded in the right cornual area. Diagnostic hysteroscopy performed with a rigid continuous-flow hysteroscope and saline-solution confirmed partial embedding; an endometrial polypectomy was required before removal. Attempts to remove the IUD with 5 Fr grasping forceps - a miniaturized retrieval instrument - failed, necessitating careful myometrial dissection using 5 Fr needle-tip electrodes - powered by radiofrequency electrical energy (Versapoint, Ethicon) - and 5 Fr scissors under continuous laparoscopic-guidance. A 5 Fr tenaculum was then used for extraction, and final laparoscopic inspection confirmed serosal integrity. In the second case, ultrasound demonstrated an IUD embedded in the posterior wall. Incisions performed with electrosurgical instruments enlarged the access tract, enabling gentle extraction under direct vision.

IUD embedment within the myometrium may complicate device removal and be associated with complications. Preoperative ultrasound is essential to assess device depth and proximity to the serosa. In the first case, the IUD appeared to be in close proximity to the serosa; given the concern for potential injury within the infraligamentary region, including uterine perforation and possible vascular or adjacent organ damage, a precautionary laparoscopic guidance was preferred. In the second case, laparoscopic assistance was not required, as ultrasound demonstrated an IUD embedded in the isthmic portion without close contact with the serosa, and the risk of perforation was therefore considered low. Electrosurgery is a useful equipment, but mechanical tools are preferable when working deep within the myometrium, as they allow more precise movements. Further studies are needed to standardize management. VIDEO ABSTRACT.