Design: A case study with preoperative images, surgical video, and postoperative follow-up with second-look hysteroscopy is reviewed.

Setting: Care took place at an outpatient academic clinic of a tertiary care center in the Bronx, New York. The patient was positioned in lithotomy.

Patients or Participants: A 39-year-old G1P0010 with a history of an abdominal myomectomy presented with secondary infertility and amenorrhea presented to the clinic for an office hysteroscopy after unsuccessful attempt at hysteroscopic adhesiolysis in the operating room. Saline-infused sonohysterogram was unable to achieve cavity distension but demonstrated a laterally deviated retroflexed uterus with a heterogenous endometrial lining.

Interventions: Vaginoscopy was used for entry. Office hysteroscopy revealed a stenotic internal cervical os, nearly obliterated intrauterine cavity, and a type 2 fibroid. Hysteroscopic forceps and scissors were used without electrosurgery to perform lysis of adhesions, restore the uterine cavity, evacuate old hematometra, and identify bilateral tubal ostia.

Measurements and Main Results: At the end of the office hysteroscopy, normal cavity contour was restored and bilateral tubal ostia were visualized. There were no complications. The procedure took 32 minutes and patient tolerated it very well. Follow-up revealed loose adhesion recurrence with overall maintained cavity.

Conclusion: This case demonstrates the utility of several hysteroscopic techniques that can be employed to treat severe IUAs safely and in a timely fashion well tolerated by the patient in the office.