Two Methods for Adenomyotic Cyst Excision

Abstract

<h3>Study Objective</h3> The objective of this video is to demonstrate two techniques for hysteroscopic resection of adenomyotic cysts. <h3>Design</h3> N/A. <h3>Setting</h3> A patient desiring fertility presents for further evaluation. Imaging is notable for two fundal cysts on ultrasound consistent with adenomyosis. After informed consent is obtained, OR hysteroscopy is performed under ultrasound guidance. <h3>Patients or Participants</h3> One patient with adenomyotic cysts is highlighted. <h3>Interventions</h3> The patient is taken to the operating room and a 5.5mm rigid hysteroscope is advanced to the fundus under ultrasound guidance. After confirming the location of adenomyotic cysts via ultrasound, hysteroscopic scissors are used to open the cysts, with adenomyosis confirmed by release of chocolate brown fluid. Cyst walls are resected in their entirety, one sharply and one with bipolar loop. <h3>Measurements and Main Results</h3> Direct visualization of the endometrial cavity as well as intraoperative ultrasound confirm complete removal of adenomyotic cysts. Pathology of the cyst walls confirmed adenomyosis. <h3>Conclusion</h3> Hysteroscopic resection of adenomyosis is safe and effective in select patients with focal disease, allowing for targeted removal under direct visualization. Here we demonstrate two hysteroscopic techniques for resection of adenomyotic cyst wall: sharp dissection, and the bipolar loop electrode.