【Hysteroscope】Removal of foreign body under hysteroscope
Hysteroscopic foreign body removal method: Utilize hysteroscope, direct clamping with forceps under the guidance of B-ultrasound, or under anesthesia, hysterectomy loop electrode resection and needle electrode incision and removal.
First, perform a combined hysteroscopy and B-ultrasound examination to determine the location, shape, size, presence or absence of incarceration, depth of incarceration, and uterine cavity condition of the foreign body in the uterus. If surgery is needed, 400μg of misoprostol was taken orally the night before, and 200μg of misoprostol was placed in the cervical canal 4h before surgery. Using continuous epidural anesthesia, uterine dilatation fluid is 5% glucose, the cervix is dilated to size 10 before the operation, and the foreign body is clamped out by the hysteroscope or the uterine cavity is removed. B-ultrasound monitoring is performed during the operation to avoid uterine perforation.
1. Intrauterine contraceptive device: take out the foreign body with forceps under the direct vision of the hysteroscope. If the intrauterine contraceptive device is incarcerated in the muscle layer, first perform hysteroscopy positioning, guide the removal of the device, and directly use the hook to remove it or Hook out to the cervix and pull the wire out. If the metal ring is broken, the cross arm of the T-ring should be clamped out with hysteroscope foreign body forceps, and the T-ring tail wire should be clamped out under the direct vision of the hysteroscope, if the uterine cavity is adhered. For those who cannot enter the uterine cavity, the cervical canal and the uterine cavity adhesion tissue should be cut with the hysteroscope under the guidance of B-ultrasound, and then the foreign body can be clamped out by the hysteroscope.
2. Embryo residues: The remaining embryos on the uterine wall that have undergone debridement or curettage are not clean and organised, and the remaining embryos are removed under B-ultrasound guidance with the ring electrode of the surgical resection microscope, and the removal is confirmed by pathology.
3. Residual fetal bone: Take out the fetal bone under B-ultrasonic monitoring. If the fetal bone embedded in the muscle wall is cut and separated by the hysterectomy ring electrode and the needle electrode, it is positioned and taken out.
4. Suture silk thread: the suture silk thread visible in the lower part of the anterior wall of the uterus under hysteroscopy, cut with a needle electrode and then clamped out by foreign body forceps.
5. Left-over gauze: Cut through the needle-shaped hysteroscope and remove the left-over gauze suture with forceps.
The removal of foreign bodies under hysteroscopy should be performed under the supervision of B-ultrasound. The hysteroscopy can find foreign bodies in the uterus, but sometimes foreign bodies embedded in the wall of the uterus or buried under the endometrium cannot be found. It can be combined with B-ultrasound. Accurate diagnosis, B-ultrasound monitoring during operation can also guide the placement of hysteroscopy instruments, display the scope and depth of removal of foreign bodies, prevent and timely discover uterine perforation.
