Hysteroscopic Adhesiolysis Using Holmium YAG Laser in Patients with Asherman's Syndrome – Easy, Effective & Safe

Abstract

Study Objective To evaluate the efficacy and safety of hysteroscopic adhesiolysis with Holmium YAG (Ho:YAG) Laser in patients with stage 2 and 3 Asherman's syndrome (ASRM classification). Design Prospective study of patients operated from April 2016 to August 2019. Setting Tertiary centre dedicated to Obstetrics, Gynaecology and Urology. Patients or Participants 23 women of Asherman's syndrome diagnosed on the basis of clinical presentation, transvaginal ultrasound and hysteroscopy. Interventions Hysteroscopic adhesiolysis was done using Holmium YAG laser delivered through a 400 micron quartz fibre at a power setting of 15 Watts. Normal saline at a pressure of 100 mm of Hg was used as the distending medium. Simultaneous laparoscopy was done in 14 patients. Post-operative intracavitary Foley catheter and sequential oestrogen & progesterone therapy was given for prevention of adhesion recurrence. Relook hysteroscopy was done in all patients after 2 months. Measurements and Main Results Mean operative time was 25 minutes (18 – 45 minutes). Stage 2 adhesions were seen in 15 patients & stage 3 in 8 patients. There were no intra or post-operative complications. 22 patients regained normal menstrual pattern (average flow). There were flimsy adhesions in 3 patients and dense adhesions in 1 patient on relook hysteroscopy. Adhesiolysis was done again with Ho:YAG laser. Mid cycle transvaginal ultrasound showed significant improvement in endometrial thickness (average of 7.4 mm). Follow up of the 18 patients for 12 months showed clinical pregnancies in 12 patients (66.7%) & 9 live births (50.0%) without any intra or postpartum complications. Conclusion Hysteroscopic adhesiolysis with Holmium YAG laser in stage 2 and stage 3 Asherman's syndrome is an effective, safe and easy procedure which helps to improve the menstrual function and the reproductive outcome in these patients. To evaluate the efficacy and safety of hysteroscopic adhesiolysis with Holmium YAG (Ho:YAG) Laser in patients with stage 2 and 3 Asherman's syndrome (ASRM classification). Prospective study of patients operated from April 2016 to August 2019. Tertiary centre dedicated to Obstetrics, Gynaecology and Urology. 23 women of Asherman's syndrome diagnosed on the basis of clinical presentation, transvaginal ultrasound and hysteroscopy. Hysteroscopic adhesiolysis was done using Holmium YAG laser delivered through a 400 micron quartz fibre at a power setting of 15 Watts. Normal saline at a pressure of 100 mm of Hg was used as the distending medium. Simultaneous laparoscopy was done in 14 patients. Post-operative intracavitary Foley catheter and sequential oestrogen & progesterone therapy was given for prevention of adhesion recurrence. Relook hysteroscopy was done in all patients after 2 months. Mean operative time was 25 minutes (18 – 45 minutes). Stage 2 adhesions were seen in 15 patients & stage 3 in 8 patients. There were no intra or post-operative complications. 22 patients regained normal menstrual pattern (average flow). There were flimsy adhesions in 3 patients and dense adhesions in 1 patient on relook hysteroscopy. Adhesiolysis was done again with Ho:YAG laser. Mid cycle transvaginal ultrasound showed significant improvement in endometrial thickness (average of 7.4 mm). Follow up of the 18 patients for 12 months showed clinical pregnancies in 12 patients (66.7%) & 9 live births (50.0%) without any intra or postpartum complications. Hysteroscopic adhesiolysis with Holmium YAG laser in stage 2 and stage 3 Asherman's syndrome is an effective, safe and easy procedure which helps to improve the menstrual function and the reproductive outcome in these patients.