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1024 Hysteroscopic suture fixation of levonorgestrel-releasing intrauterine device in fertility sparing treatment of endometrial cancer
  1. Tucci Claudia,
  2. Luca Nardone,
  3. Gretha Orlandi,
  4. Francesca De Bonis,
  5. Claudia Maccarrone,
  6. Massimiliano Fambrini and
  7. Flavia Sorbi
  1. Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Florence, Italy


Introduction/Background B.I. had a history of irregular menstrual cycles, dysmenorrhea, and a BMI of 59 with insulin resistance. Following a hysteroscopic polypectomy in April 2021, histopathologic examination revealed endometrial intraepithelial neoplasia (EIN).

Considering her age and desire for fertility preservation, a levonorgestrel-releasing IUD (20mcg) was initially chosen as a treatment option. However, subsequent check-ups revealed four spontaneous expulsions of the devices and the presence of EIN. After unsuccessful attempts with various treatments, including leuprorelin acetate and medroxyprogesterone acetate, a multidisciplinary team recommended a total hysterectomy and bilateral salpingectomy, which the patient declined.

Despite persistent endometrial hyperplasia with focal atypia in September 2022, a negative MRI in December 2022 supported the decision to continue fertility-sparing treatment with LNG-IUS. Searching in literature we found that Zhu et al. in 2021, Zhang et al. in 2022, Huang in 2022 described suture fixation of LNG-IUS in patients with adenomyosis.

There are no data regarding this technique for fertility sparing therapy in endometrial cancer.

Methodology This case study focuses on a 37-year-old woman, diagnosed with EIN. Due to multiple expulsions of LNG-IUS, hysteroscopic suture fixation was performed to prevent further displacement.

Results In December 2022, a novel approach was implemented, involving hysteroscopy, diagnostic curettage, and extensive endometrial excisions to anchor the IUD in the posterior cervical wall using a 4/0 Stratafix. Histological examination post-intervention revealed simple hyperplasia without atypia. Notably, since December 2022, there has been no IUD displacement. In December 2023, additional biopsies were performed, and the IUD was repositioned using the same methodology. The extended period of IUD retention was attributed to the successful fixation.

Conclusion The hysteroscopic fixation of LNG-IUS in this case allowed for sustained IUD retention. However, further follow-up and a larger case series are necessary to establish the long-term efficacy of this innovative approach.

Disclosures The authors do not have any conflicts of interest to declare.

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