A stepwise approach to the hysteroscopic management of cystic adenomyosis

Evy Gillet, Gillet E, Van Kerrebroeck H, Helena Van Kerrebroeck, Kerrebroeck H, Panayiotis Tanos, Tanos P, Stavros Karampelas, Karampelas S, Sugihara A, Alessa Sugihara, Argay I, Istvan Argay, István Argay, Marion H. Valkenburg, Marion Valkenburg, Valkenburg M, Gordts S, Stephan Gordts, Rudi Campo, Campo R
Facts, views & vision in ObGyn · 2026 · vol. 18(3) , pp. 269–270 · doi:10.52054/fvvo.2026.407 · PMID:42740633 · PMC13575365 · W7213352680
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⚙ AI-generated summary by qwen3.7-flash, 2026-10-01 ⓘ

This paper presents a reproducible hysteroscopic technique for managing focal cystic adenomyosis using ultrasound-hysteroscopic correlation to identify and resect lesions in women with infertility.

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This video commentary outlines a reproducible, stepwise hysteroscopic technique for identifying and treating focal cystic adenomyosis of the inner myometrium in women with infertility. The approach integrates transvaginal ultrasound with digital hysteroscopy to map lesions via bipolar-marker correlation, followed by meticulous resection using mini-resectoscope instruments and application of an anti-adhesion barrier. Structured postoperative follow-up includes second-look hysteroscopy when necessary to ensure complete management. This paper is centrally about adenomyosis — specifically the hysteroscopic management of focal cystic lesions within the inner myometrium.

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Abstract

BACKGROUND: Adenomyosis may alter the functional architecture of the inner myometrium and has been associated with impaired reproductive outcomes. Focal cystic adenomyotic lesions can persist despite hormonal suppression and may be challenging to identify and treat hysteroscopically. OBJECTIVES: To demonstrate a reproducible, stepwise, hysteroscopic technique for the identification and management of focal cystic adenomyosis of the inner myometrium. PARTICIPANT: Women with infertility and recurrent implantation failure, defined as failure to achieve a clinical pregnancy after repeated embryo transfers, diagnosed with focal cystic adenomyosis of the inner myometrium based on transvaginal ultrasound and hysteroscopic assessment. INTERVENTION: Procedures were performed in an ambulatory digital hysteroscopy setting at the Life Expert Centre (Leuven, Belgium) under conscious sedation. The approach combined hysteroscopy and transvaginal ultrasound throughout diagnosis, treatment, and follow-up. Preoperative hormonal suppression was used to identify lesions persisting despite medical therapy. Key steps were: (1) lesion mapping using ultrasound-hysteroscopic correlation, including bipolar-marker topographic correlation of lesions not directly visible during hysteroscopy; (2) meticulous dissection and resection using 5Fr mechanical instruments and / or a bipolar loop within a 15Fr mini-resectoscope; (3) application of a crosslinked hyaluronic acid anti-adhesion barrier; and (4) structured postoperative follow-up, including second-look hysteroscopy when indicated. CONCLUSIONS: Combination of hysteroscopy and transvaginal ultrasound enables minimally invasive management of focal cystic adenomyosis of the inner myometrium. This video demonstrates a reproducible approach based on precise lesion identification, targeted treatment, and structured postoperative assessment. WHAT IS NEW?: This video introduces a novel technique of topographic ultrasound-hysteroscopic correlation using bipolar-marker localisation, facilitating the identification and treatment of adenomyotic cysts not directly visible during hysteroscopy.
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Abstract

Background: Adenomyosis may alter the functional architecture of the inner myometrium and has been associated with impaired reproductive outcomes. Focal cystic adenomyotic lesions can persist despite hormonal suppression and may be challenging to identify and treat hysteroscopically.

Objectives

To demonstrate a reproducible, stepwise, hysteroscopic technique for the identification and management of focal cystic adenomyosis of the inner myometrium. Participant: Women with infertility and recurrent implantation failure, defined as failure to achieve a clinical pregnancy after repeated embryo transfers, diagnosed with focal cystic adenomyosis of the inner myometrium based on transvaginal ultrasound and hysteroscopic assessment. Intervention: Procedures were performed in an ambulatory digital hysteroscopy setting at the Life Expert Centre (Leuven, Belgium) under conscious sedation. The approach combined hysteroscopy and transvaginal ultrasound throughout diagnosis, treatment, and follow-up. Preoperative hormonal suppression was used to identify lesions persisting despite medical therapy. Key steps were: (1) lesion mapping using ultrasound-hysteroscopic correlation, including bipolar-marker topographic correlation of lesions not directly visible during hysteroscopy; (2) meticulous dissection and resection using 5Fr mechanical instruments and / or a bipolar loop within a 15Fr mini-resectoscope; (3) application of a crosslinked hyaluronic acid anti-adhesion barrier; and (4) structured postoperative follow-up, including second-look hysteroscopy when indicated.

Conclusions

Combination of hysteroscopy and transvaginal ultrasound enables minimally invasive management of focal cystic adenomyosis of the inner myometrium. This video demonstrates a reproducible approach based on precise lesion identification, targeted treatment, and structured postoperative assessment. What is New? This video introduces a novel technique of topographic ultrasound-hysteroscopic correlation using bipolar-marker localisation, facilitating the identification and treatment of adenomyotic cysts not directly visible during hysteroscopy.

Keywords

Adenomyosis, hysteroscopy, ultrasonography, infertility, reproduction, technique Facts Views Vis Obgyn 2026;18(3):269-270 270

Acknowledgements

Not applicable. Contributors: Surgical and Medical Practices: E.G., H.V .K., R.C., Concept: E.G., R.C., Design: E.G., R.C., Data Collection or Processing: E.G., R.C., Analysis or Interpretation: E.G., R.C., Literature Search: E.G., H.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., I.A., M.V ., S.G., R.C. Funding: The authors declared that this study received no financial support. Competing interests: One of the authors, Rudi Campo, is a member of the editorial board of the Facts, Views and Vision in ObGyn. The editorial and peer-review process was conducted independently of this author. The other authors declare no conflicts of interest. Ethical approval: Not applicable. Informed consent: Written informed consent was obtained from all patients for surgical treatment and use of anonymized clinical data and video material for publication. Data sharing: Data are available from the corresponding author upon request. Transparency: The authors affirm that this video article is an accurate and transparent account of the work presented, and that no important aspects have been omitted. Video 1. A stepwise approach to the hysteroscopic management of cystic adenomyosis: https://youtu.be/1Bu-W40SIMY

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