title: Hysteroscopic morcellator to overcome cervical stenosis.
abstract: OBJECTIVE
  To report a step-by-step technique to using a hysteroscopic morcellator to safely gain access into the intrauterine cavity in two patients with severe cervical stenosis and concomitant intrauterine pathology.
  
  
  METHODS
  Video article introducing the hysteroscopic morcellator for overcoming severe cervical stenosis.
  
  
  METHODS
  Academic-based practice.
  
  
  METHODS
  A 36-year-old G0 female with primary infertility and uterine polyps and a 34-year-old G0 female with uterine polyps and a difficult trial transfer before undergoing an IVF cycle. In both patients, preoperative saline-infused sonography revealed submucosal filling defects and severe cervical stenosis.
  
  
  METHODS
  A hysteroscopic technique using the Hologic Myosure to overcome severe cervical stenosis with or without the use of intraoperative ultrasound.
  
  
  METHODS
  Despite using preoperative Cytotec, cervical stenosis was identified. Under direct visualization, a 4-mm Myosure XL blade was placed through a 7.25-mm Myosure XL hysteroscopy. The cutter blade, powered by an electromechanical drive system, enables simultaneous rotation and reciprocation. The blade allows one to shave and remove tissue and is applied to cervical stenosis, allowing safe access into the intrauterine cavity.
  
  
  RESULTS
  The intrauterine hysteroscopic Myosure morcellator allowed for safe and direct entry into the uterine cavity. We have since applied this technique to all patients where cervical stenosis is identified and have minimized potential uterine perforation and false tracks in our patients.
  
  
  CONCLUSIONS
  Our technique is an alternative method for overcoming severe cervical stenosis and minimizing potential intraoperative complications.
authors.affiliation: Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Bijan W
authors.initials: BW
authors.lastname: Salari
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York.
authors.forename: Bala
authors.initials: B
authors.lastname: Bhagavath
authors.affiliation: Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Galloway
authors.affiliation: Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, Wright-Patterson Air Force Base, Dayton, Ohio.
authors.forename: Austin D
authors.initials: AD
authors.lastname: Findley
authors.affiliation: Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Yaklic
authors.affiliation: Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio. Electronic address: steven.lindheim@wright.edu.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000601:surgery*; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000295:instrumentation*; D007247:Infertility, Female / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011127:Polyps / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D002577:Uterine Cervical Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014591:Uterine Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Cervical stenosis; challenging cervix; hysteroscopy; intraoperative ultrasound; morcellation