Vaginoscopic technique combined with bypass intrauterine device removal: a novel method using in difficult...

The success of intrauterine device (IUD) removal is influenced by various factors, including IUD type, placement duration, history of cesarean section or cervical surgery, menopausal status, operator expertise, intrauterine adhesions (IUAs), and IUD embedment. Traditional ultrasound-guided IUD removal involves vaginal speculum insertion, cervical dilation, and uterine cavity assessment, which carry risks of uterine perforation and incomplete removal. In postmenopausal patients, cervical stenosis and atrophy make cervical traction difficult, and blind manipulation further increases perforation risks. Conventional hysteroscopy is also ineffective in addressing these challenges. Mini-hysteroscopy (3.8-4.5 mm) via vaginoscopic access offers a solution by eliminating the need for anesthesia, speculum use, cervical dilation, or cervical pretreatment, allowing direct visualization of the uterine cavity. Embedded IUDs can be dissected using 5-Fr scissors under hysteroscopic guidance. Compared to 5-Fr instruments, the IUD removal hook is more cost-effective and mechanically stronger. The combination of vaginoscopic technique and bypass IUD removal achieves higher success rates, reduces damage from 5-Fr instruments, and eliminates reliance on ultrasound monitoring. This case involves a 70-year-old patient with a history of IUD placement for 40 years and 20 years post-menopause. The procedure was completed in 15 minutes, whereas traditional hysteroscopic requires at least 60 minutes. This technique is particularly suitable for postmenopausal patients with circular metal IUDs.