Hysteroscopic removal of a retained intrauterine foreign body: a step-by-step technique

Background Retained intrauterine foreign bodies are rare but may cause abnormal uterine bleeding (AUB) and pelvic pain. Hysteroscopy is the preferred approach for diagnosis and management. Objectives This video describes a step-by-step hysteroscopic technique for intrauterine foreign body removal. Participant A 60-year-old woman presented with pelvic pain and AUB. She underwent resectoscopic polypectomy three years before. A computed tomography scan revealed a cylindrical foreign body (12x8 millimetres) in the uterine cavity. The patient was referred to the Digital Hysteroscopic Clinic CLASS Hysteroscopy in Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, where she was scheduled for a minimally invasive hysteroscopic procedure. Intervention Hysteroscopic evaluation identified a tubular foreign body firmly adherent to the posterior uterine wall. Removal was performed using a hysteroscopic approach combined with a traction suture technique. First, 5 Fr scissors were used to detach the foreign body from the posterior uterine wall. Then, a Collins electrode of a 15 Fr bipolar miniresectoscope was employed to incise the lateral isthmic walls to facilitate extraction. Finally, a 0 Vicryl traction suture loop, inserted through the foreign body using 5 Fr grasping forceps, enabled controlled removal under hysteroscopic guidance. The foreign body was successfully extracted. Conclusions This video demonstrates a step-by-step hysteroscopic technique for intrauterine foreign body removal, highlighting the safety and precision of this minimally invasive approach. What is New? This is the first reported case of hysteroscopic removal of a retained intrauterine foreign body, using a traction suture technique under hysteroscopic guidance for a controlled extraction.