Design: Video presentation of case series

Setting: Outpatient setting - office hysteroscopy with patient in lithotomy position.

Patients or Participants: 5 patients seen in the Gynecology office in the setting of previous failed or incomplete IUD removal, or with imaging findings of a malpositioned or embedded IUD.

Interventions: Operative office hysteroscopy

Measurements and Main Results: Preoperative imaging was reviewed as part of surgical planning in order to increase the safety of the procedures. Office set up is described. Advanced hysteroscopic techniques are portrayed for removal of embedded IUDs, including cephalad traction of the device arms, dissection of the overlying endometrium and myometrium, twisting of the IUD while pulling, and grasping of the IUD strings even when they are intracavitary.

Conclusion: Removal of challenging IUD or IUD fragments is feasible using office hysteroscopy using semi rigid scissors and semi rigid graspers, though more difficult cases may require a procedure in the operating room for patient comfort.