{"paper_id":"6156794a-0530-4fc3-8363-b0bde87ac1c9","body_text":"269\nCopyright© 2026 The Author(s). Published by Galenos Publishing House on behalf of European Society for Gynaecological Endoscopy. \nThis is an open-access article under the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License.\nFacts Views Vis Obgyn 2026;18(3):269-270\nVIDEO COMMENTARY\nDOI: 10.52054/FVVO.2026.407\nA stepwise approach to the hysteroscopic management \nof cystic adenomyosis\n Evy Gillet1,2,  Helena Van Kerrebroeck1,  Panayiotis Tanos1,2,  Stavros Karampelas1,2,  Alessa Sugihara1, \n Istvan Argay1,  Marion Valkenburg1,  Stephan Gordts1,  Rudi Campo1\n1Life Expert Centre, Leuven, Belgium\n2Department of Gynaecology and Obstetrics, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium\nCorresponding Author: Evy Gillet, MD, Life Expert Centre, Leuven; Department of Gynaecology and Obstetrics, Centre \nHospitalier Universitaire Brugmann, Brussels, Belgium\nE-mail: evy.gillet@lifeexpertcentre.be ORCID ID: orcid.org/0009-0002-3054-4837\nReceived: 01.03.2026 Accepted: 30.07.2026 Publication Date: 15.09.2026\nCite this article as: Gillet E, Van Kerrebroeck H, Tanos P , Karampelas S, Sugihara A, Argay I, et al. A stepwise approach to the \nhysteroscopic management of cystic adenomyosis. Facts Views Vis Obgyn. 2026;18(3):269-270\nABSTRACT\nBackground: Adenomyosis may alter the functional architecture of the inner myometrium and has been associated with \nimpaired reproductive outcomes. Focal cystic adenomyotic lesions can persist despite hormonal suppression and may \nbe challenging to identify and treat hysteroscopically.\nObjectives: To demonstrate a reproducible, stepwise, hysteroscopic technique for the identification and management \nof focal cystic adenomyosis of the inner myometrium.\nParticipant: Women with infertility and recurrent implantation failure, defined as failure to achieve a clinical pregnancy \nafter repeated embryo transfers, diagnosed with focal cystic adenomyosis of the inner myometrium based on transvaginal \nultrasound and hysteroscopic assessment.\nIntervention: Procedures were performed in an ambulatory digital hysteroscopy setting at the Life Expert Centre (Leuven, \nBelgium) under conscious sedation. The approach combined hysteroscopy and transvaginal ultrasound throughout \ndiagnosis, treatment, and follow-up. Preoperative hormonal suppression was used to identify lesions persisting despite \nmedical therapy. Key steps were: (1) lesion mapping using ultrasound-hysteroscopic correlation, including bipolar-marker \ntopographic correlation of lesions not directly visible during hysteroscopy; (2) meticulous dissection and resection using \n5Fr mechanical instruments and / or a bipolar loop within a 15Fr mini-resectoscope; (3) application of a crosslinked \nhyaluronic acid anti-adhesion barrier; and (4) structured postoperative follow-up, including second-look hysteroscopy \nwhen indicated.\nConclusions: Combination of hysteroscopy and transvaginal ultrasound enables minimally invasive management of \nfocal cystic adenomyosis of the inner myometrium. This video demonstrates a reproducible approach based on precise \nlesion identification, targeted treatment, and structured postoperative assessment.\nWhat is New?  This video introduces a novel technique of topographic ultrasound-hysteroscopic correlation using \nbipolar-marker localisation, facilitating the identification and treatment of adenomyotic cysts not directly visible during \nhysteroscopy.\nKeywords: Adenomyosis, hysteroscopy, ultrasonography, infertility, reproduction, technique\n\nFacts Views Vis Obgyn 2026;18(3):269-270\n270\nAcknowledgements: Not applicable.\nContributors: Surgical and Medical Practices: E.G., H.V .K., R.C., \nConcept: E.G., R.C., Design: E.G., R.C., Data Collection or Processing: \nE.G., R.C., Analysis or Interpretation: E.G., R.C., Literature Search: E.G., \nH.V .K., P .T., S.K., A.S., I.A., M.V ., S.G., R.C., Writing: E.G., P .T., S.K., A.S., \nI.A., M.V ., S.G., R.C.\nFunding: The authors declared that this study received no financial \nsupport.\nCompeting interests: One of the authors, Rudi Campo, is a member \nof the editorial board of the Facts, Views and Vision in ObGyn. The \neditorial and peer-review process was conducted independently of this \nauthor. The other authors declare no conflicts of interest.\nEthical approval: Not applicable.\nInformed consent:  Written informed consent was obtained from all \npatients for surgical treatment and use of anonymized clinical data and \nvideo material for publication.\nData sharing: Data are available from the corresponding author upon \nrequest.\nTransparency: The authors affirm that this video article is an accurate \nand transparent account of the work presented, and that no important \naspects have been omitted.\nVideo 1. A stepwise approach to the hysteroscopic management of cystic adenomyosis: \nhttps://youtu.be/1Bu-W40SIMY","source_license":"public-domain-us","license_restricted":false}