Single-Port Hysteroscopy for Perforated IUD Removal

Intrauterine devices provide reliable long-acting reversible contraception worldwide. However, uterine perforation remains a rare yet serious complication that requires prompt surgical intervention. Clinicians traditionally rely on multi-port laparoscopy for perforated IUD removal. Recently, surgeons introduced a single-port transabdominal hysteroscopic approach that minimizes surgical trauma and speeds patient recovery.

Clinical Challenges in Perforated IUD Removal

Uterine perforation occurs in approximately 0.2 to 3.6 per 1,000 insertions. Lactating women and postpartum patients experience higher baseline risks for this event. In addition, uterine malformations and provider inexperience elevate complication rates. Although many patients remain asymptomatic initially, migrated devices can trigger pelvic pain and inflammatory adhesions. Therefore, surgeons must retrieve extrauterine devices before severe complications develop. Multi-port laparoscopy has long served as the standard surgical solution. Nevertheless, multi-port techniques increase incision pain and post-procedure scarring.

Stepwise Technique for Single-Port Extraction

Preoperative localization begins with precise pelvic ultrasound and abdominal radiographs. Consequently, clinicians can rule out adjacent bowel or bladder injury before entering the operating room. During the procedure, the surgeon places a single laparoscopic trocar into the peritoneal cavity. Next, the surgeon introduces a continuous-flow hysteroscope through this single port. Surgeons then visualize the peritoneal cavity clearly without requiring multiple abdominal punctures. Hysteroscopic graspers carefully release omental adhesions and secure the device. Subsequently, the surgeon withdraws the device and instruments simultaneously through the single cannula.

Patient Selection and Safety Considerations

This single-port hysteroscopic method suits patients with uncomplicated intra-abdominal device displacement. However, patients with bowel perforations, pelvic abscesses, or dense retroperitoneal scarring require traditional multi-port laparoscopy. If visualization proves inadequate or bleeding occurs, surgeons can quickly place supplementary trocars. Thus, this innovative technique maintains high surgical safety without compromising clinical flexibility. Overall, adopting single-port hysteroscopy offers gynecologists a practical and gentle alternative for selected cases.

Frequently Asked Questions

Q1: What are the main benefits of single-port hysteroscopic IUD retrieval?

This approach minimizes abdominal incisions, reduces postoperative pain, and shortens patient recovery times. Furthermore, surgeons retain the option to convert easily to standard laparoscopy if needed.

Q2: Which patients are suitable candidates for this single-port technique?

The technique works best for patients with intra-abdominal IUD displacement without bowel injury, bladder perforation, or active pelvic abscesses.

Q3: How do surgeons prepare for the procedure preoperatively?

Clinicians perform pelvic ultrasonography and abdominal X-rays to locate the device precisely and exclude damage to surrounding pelvic viscera.

References

1. Marguerie M et al. Single-Port Perforated Intrauterine Device Removal With a Transabdominal Hysteroscope. Obstet Gynecol. 2026 Sep 01. doi: 10.1097/AOG.0000000000006377. PMID: 42531569.
2. Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open Access J Contracept. 2016;7:19-32.
3. Gill RS, Mok D, Hudson M, Shi X, Birch DW, Karmali S. Laparoscopic removal of an ingested foreign body: a technical review. Surg Endosc. 2012;26(10):2730-2735.