A method for safe hysteroscopic synechiolysis in patients with asherman syndrome

Background: Uterine perforation is the most common complication of hysteroscopic synechiolysis for severe Asherman syndrome. We have developed a novel technique for hysteroscopic synechiolysis in which ultrasound guidance is used to prevent perforation. Case: A 32-year-old woman with recurrent spontaneous abortions was diagnosed with Asherman syndrome after a hysteroscopic myomectomy. Synechiolysis is performed solely with hysteroscopic blunt dissection, without the use of an activated electrosurgical device. Transrectal ultrasound is used to visualize the surgical instruments in the area of the cervix, and abdominal ultrasonography guides the operative approach within the uterine cavity. Conclusions: We have successfully utilized this simple, safe technique in a patient who had developed Asherman syndrome after hysteroscopic surgery and conceived spontaneously after a hysteroscopic synechiolysis. (J GYNECOL SURG 25:147)