Hysteroscopic Intrauterine Device Removal: Adapting the Use of Ultrasound in the Operating Room

INTRODUCTION: The integration of imaging technology in surgical interventions has the potential to significantly enhance surgical outcomes. In this video, we demonstrate the critical role of ultrasound in accurately localizing a retained IUD arm, highlighting its unique application intraoperatively to improve identification and removal of the foreign body. OBJECTIVE: This video serves to illustrate the innovative application of preoperative ultrasound images during the hysteroscopic removal of a retained copper intrauterine device (IUD) arm in a 42-year-old female patient. It also highlights the use of advanced hysteroscopic techniques—such as employing an angled hysteroscope lens, adjusting intracavitary pressures, and applying vector forces—to optimize the removal of foreign bodies. METHODS: Preoperative imaging, including abdomino-pelvic X-ray and pelvic ultrasound, effectively identified the location of the missing right transverse arm of the IUD. During the hysteroscopic procedure, ultrasound images provided real-time critical guidance to locate the proximal end of the IUD arm. These images distinctly outlined both the embedded proximal and distal ends within the cervical stroma, while the accompanying video illustrated its trajectory. Hysteroscopic scissors were employed to dissect surrounding tissue, enhancing visibility and access. After encountering initial resistance during removal, modifications to the traction technique led to the successful extraction of the intact IUD arm. RESULTS: This case highlights the critical role of ultrasound in enhancing the efficacy and safety of hysteroscopic procedures, particularly in complex scenarios involving retained devices. Key takeaways include the importance of imaging in procedural planning and the adaptability of techniques to achieve successful outcomes. CONCLUSIONS: Utilizing preoperative imaging during the hysteroscopic removal of foreign objects enhances the localization of these items by providing clear orientation and identifying key anatomical landmarks. To optimize visualization during hysteroscopy, it is essential to adjust the angled hysteroscope and lower intracavitary pressures.