Hysteroscopic Approaches to the Removal of Malpositioned Intrauterine Devices (IUDs)

Study Objective The objectives of this video are to (1) demonstrate both common and uncommon clinical presentations of a malpositioned intrauterine device (IUD) and (2) demonstrate appropriate removal techniques, including those ideal for both the office and operating room setting. Design Surgical technique demonstration Setting All procedures were conducted at an academic medical center. Procedures were performed in the office setting and operating room where appropriate. The office setting includes both routine exam rooms and procedure suites. Operating room based procedures are performed in an outpatient surgery center. The patients are positioned in lithotomy using built-in table stirrups in the office and either candy cane or boot stirrups in the operating room. Patients or Participants Photo and video footage was collected from patients managed within the gynecology division at our institution. All patients agreed to the use of photos and videos for educational purposes via an informed consent process. Interventions Using a combination of surgical footage, 3-dimensional animation and imaging (ultrasound, MRI), the video progresses through several different scenarios of malpositioned and embedded IUDs and corresponding techniques for removal. These techniques include caudal traction, sharp dissection, electrosurgical dissection, cranial-caudal motion, and rotation. Measurements and Main Results n/a Conclusion This video reviews the clinical approach to the removal of malposition.