{"paper_id":"90a7def8-a2e4-4b5a-8c32-f22cb109300e","body_text":"https://doi.org/10.1007/s12262-022-03611-0\nSURGICAL TECHNIQUES AND INNOVATIONS\nTwo Paths of Suture Fixation for Levonorgestrel‑Releasing Intrauterine \nDevices Under Hysteroscopy\nJinCheng Huang1,2  · SuZhen Jiang3 · WenJian Zhang1,2 · Min Guo1,2 · CuiFen Li1,2 · YanYan Liu1,2\nReceived: 28 September 2022 / Accepted: 25 October 2022 \n© The Author(s) 2022\nAbstract\nFor patients with adenomyosis who are treated with a levonorgestrel-releasing intrauterine device (LNG-IUD), is there a better \nway to keep LNG-IUD from falling off? This paper introduced two ways to suture fixation of LNG-IUD under hysteroscopy. One \nway was to use the instrument channel in the hysteroscopic cold-knife surgery system (Zhu et al. in Fertil steril 116:1191-1193, \n1), and the other way was to enter the uterine cavity from the side of the hysteroscope. A video description of the surgical pro-\ncedure demonstrates the detailed technique. We sutured the LNG-IUD in two different ways as shown in the video. One method \nwas to suture with a 3 mm needle holder through the operating channel; another option was to suture from the bypass. After \nthe intrauterine suture, the suture needle was pulled out, and the middle part of the thread was tied to the top of the LNG-IUD. \nThe knot was tied with a knot push device, and the hysteroscopy was performed again to determine the position of the knot and \nLNG-IUD, and the end of the suture was cut 1 cm from the knot. Case 1: A 42-year-old patient, gravida 4, para 2, underwent \nhysteroscopy 1 year ago due to adenomyosis. Postoperative pathology was endometrial hyperplasia. She was treated with LNG-\nIUD but unfortunately fell off twice due to cervical insufficiency. Case 2: A 47-year-old patient, gravida 3, para 2, was admitted \nto LNG-IUD 1 year ago because of adenomyosis, and the volume of menstruation decreased. The LNG-IUD fell off 3 months \nago, and the LNG-IUD moved down after re-admission. LNG-IUD was successfully sutured and fixed in the intrauterine cavity \nin both patients within 30 min. The distending media of these two paths were 4000 ml and 6000 ml, respectively. The mean \nblood loss was about 5 ml for both patients, and they left the hospital after 2 h of observation. The menstrual volume of these \ntwo patients decreased, and the ultrasound showed that the LNG-IUD was in the right position at 1 and 3 months postopera-\ntively. For patients with adenomyosis who have previously lost the LNG-IUD, these two methods of LNG-IUD fixation under \nhysteroscopy are both reliable to avoid the risk of the LNG-IUD being discharged again. The bypass method for LNG-IUD \nsuture requires only an intrauterine laparoscope, which requires less instrumentation but higher suture skills.\nKeywords Adenomyosis · Fixation · Hysteroscopy · Levonorgestrel-releasing intrauterine device\n * JinCheng Huang \n jinchenghuang2022@163.com\n1 Dongguan People’s Hospital 3, No. 1, Huangzhou Xianglong \nRoad, Shilong Town, Dongguan, China\n2 Department of Gynaecology, SSL Central Hospital \nDongguan, Affiliated Dongguan Shilong People’s \nHospital, Southern Medical University, Dongguan 523326, \nGuangdong, People’s Republic of China\n3 Tungwah Songshan Lake Hospital, Dongguan, \nGuangdong Province, China\n/ Published online: 18 November 2022 \nIndian Journal of Surgery (August 2023) 85(4):944–945\n1 3\n\nIndian Journal of Surgery (August 2023) 85(4):944–945\nSupplementary Information The online version contains supplementary \nmaterial available at https:// doi. org/ 10. 1007/ s12262- 022- 03611-0.\nDeclarations \nConsent for Publication  The authors confirmed that they provided \ninformed consent for the release of images and videos to the patients.\nCompeting Interests The authors have no competing interests.\nOpen Access This article is licensed under a Creative Commons Attri-\nbution 4.0 International License, which permits use, sharing, adapta -\ntion, distribution and reproduction in any medium or format, as long \nas you give appropriate credit to the original author(s) and the source, \nprovide a link to the Creative Commons licence, and indicate if changes \nwere made. The images or other third party material in this article are \nincluded in the article's Creative Commons licence, unless indicated \notherwise in a credit line to the material. If material is not included in \nthe article's Creative Commons licence and your intended use is not \npermitted by statutory regulation or exceeds the permitted use, you will \nneed to obtain permission directly from the copyright holder. To view a \ncopy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.\nReference\n 1. Zhu LL, Yang XY, Cao BB, Tang SS, Tong JY (2021) The suture \nfixation of levonorgestrel-releasing intrauterine device using the \nhysteroscopic cold-knife surgery system: an original method in \ntreatment of adenomyosis. Fertil Steril 116:1191–1193. https:// \ndoi. org/ 10. 1016/j. fertn stert. 2021. 05. 113\nPublisher's Note  Springer Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.\n1 3\n945","source_license":"CC0","license_restricted":false}