Resume. The article presents the experience of using ultrasound monitoring during laser ablation in patients with common adhesions in the uterine cavity including patients with Asherman’s syndrome.
MATERIALS AND METHODS
The obstetrics and gynecology clinical department 2015 to 2020, 547 patients of 25 and 47 aged with diagnosed intrauterine adhesions and infertility were screened and tested. All patients were retrospectively divided into three groups according to the extent of intrauterine adhesions.
RESULTS
The first group of 162 patients with Asherman’s syndrome went through the laser hysteroscopic ablation of intrauterine synechiae under ultrasound control, after the operation ended, all patients were injected with anti-adhesive gel into the intrauterine cavity. The second group consisted of 212 patients with multiple fibrous fusions in lower third of the uterine cavity. Destruction of intrauterine synechiae was under ultrasound control. The third group presented 166 patients with dense single diagnosed synechiae usually in the middle or upper third of the cavity; we did not use an ultrasound control in that case. After 2-6 menstrual cycles 452 (82.6%) patients were up to hysteroscopy. 26 of 161 (22.4%) and 37 of 207 (17.8%) patients (the 1st and the 2nd groups respectively) presented a single intrauterine adhesion with further hysteroscopic re-intervention. None of the 84 patients in the third group were found throughout the control hysteroscopy of synechiae.
CONCLUSION
Ultrasonic monitoring in intrauterine laser surgery in patients with Asherman’s syndrome and multiple intrauterine synechiae allows the surgeon to act more confidently, avoid intraoperative complications, reduce the time of surgery and improve the quality of performing.