Complex uterine surgery: a cooperative role for interventional radiology with hysteroscopic surgery.

ABSTRACT

OBJECTIVE: To describe the value of concurrent interventional radiology with hysteroscopy for the management of complex intrauterine abnormalities. DESIGN: A new descriptive technique. SETTING: Tertiary care center. PATIENT(S) Three case reports. INTERVENTION(S) Interventional radiology with the placement of guidewires and/or dilatation of resistant structures may assist with hysteroscopic management of complex intrauterine abnormalities or may be a primary therapeutic option. MAIN OUTCOME MEASURE(S) Resolution of dysmenorrhea and restoration of fertility. RESULT(S) The placement of a guidewire into an occluded portion of the intrauterine cavity provides direction and safety for hysteroscopic resolution of the underlying problem. In the last case, placement of the guidewire and passing dilators over the guidewire provided complete treatment. CONCLUSION(S) The uterine cavity or a smaller segment of it may be blocked by occlusive fibrous tissue that is not amenable to standard hysteroscopic dissection. Combining radiologic imaging with hysteroscopic surgery allows visual access to instrumentation and the hidden structures or organs throughout the entire procedure. It adds complexity to the surgery but may allow restoration of function to an organ or structure that is otherwise inaccessible.