#378 : Intrauterine Suture of Levonorgestrel Intrauterine Device Under Hysteroscopy

Background and Aims: Levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective and long-term treatment for adenomyosis, especially for patients who have severe dysmenorrhea symptoms but a strong desire to preserve their uterus. However, expulsion of the device for patients with an enlarged uterus remains a problem. In this study, an LNG-IUS was stitched on the posterior wall of the uterus under hysteroscopy, which can be an alternative method to this problem. Methods: 21 patients with adenomyosis who had previously been treated with the LNG-IUS and experienced expulsion for at least one time were enrolled. The fixation of the LNG-IUD on the posterior wall of the uterus was performed with a 4-0 Ethicon polypropylene non-absorbable suture through an endoscopic needle driver and a knot-pushing device. Results: During the postoperative follow-up, all patients experienced complete remission of their symptoms: a significant decrease in menstrual flow, relief of dysmenorrhea, and improvement in quality of life. No expulsion of device and other compilations were found. Conclusions: In patients with adenomyosis suffering from dysmenorrhea or heavy menstrual blood loss, suture fixation of an LNG-IUS using the hysteroscopic cold knife surgery system is a minimally invasive and effective alternative treatment for patients with an enlarged uterus and decreases the risk of LNG-IUS expulsion.