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Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman’s syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate–carboxymethylcellulose or polyethylene oxide–sodium carboxymethylcellulose as anti-adhesive barrier.

To investigate the effect of perioperative temperature settings of an inflatable warming device on postoperative recovery quality in patients undergoing hysteroscopic myomectomy, this randomized controlled trial enrolled 258 patients receiving laryngeal mask general anesthesia at Xuzhou Central Hospital, China, between March 2022 and August 2024. Patients were allocated to perioperative temperature management with an inflatable warming device set to 38 °C (Group L, n  = 129) or 43 °C (Group H, n  = 129). A total of 211 patients were included in the final analysis after accounting for exclusions. At 24 h postoperatively, the QoR-40 score was significantly higher in Group H compared to Group L ( P  < 0.05). At baseline (T0), no significant differences in core body temperature, mean arterial pressure (MAP), or heart rate (HR) were observed between groups ( P  > 0.05). From T1 to T6, Group H exhibited higher and more stable core body temperature, MAP, and HR compared to Group L ( P  < 0.05). There were no statistically significant differences in QoR-40 scores at 48 h ( P  > 0.05) or in the incidence of postoperative restlessness, chills, and infection between the two groups. Compared to 38 °C, the perioperative application of a 43 °C inflatable warming device improved early postoperative recovery quality at 24 h in hysteroscopic myomectomy patients without increasing complication risks.

Background Cesarean scar defects (CSD) are caused by cesarean sections and cause various symptoms. Although there has been no previous consensus on the name of this condition for a long time, it has been named cesarean scar disorder (CSDi). Methods This review summarizes the definition, prevalence, and etiology of CSD, as well as the pathophysiology and treatment of CSDi. We focused on surgical therapy and examined the effects and procedures of laparoscopy, hysteroscopy, and transvaginal surgery. Main findings The definition of CSD was proposed as an anechoic lesion with a depth of at least 2 mm because of the varied prevalence, owing to the lack of consensus. CSD incidence depends on the number of times, procedure, and situation of cesarean sections. Histopathological findings in CSD are fibrosis and adenomyosis, and chronic inflammation in the uterine and pelvic cavities decreases fertility in women with CSDi. Although the surgical procedures are not standardized, laparoscopic, hysteroscopic, and transvaginal surgeries are effective. Conclusion The cause and pathology of CSDi are becoming clear. However, there is variability in the prevalence and treatment strategies. Therefore, it is necessary to conduct further studies using the same definitions. The chronic inflammation that occurs in cesarean scar defect spreads into the uterine cavity and reduces fertility. Such secondary infertility has been termed cesarean scar disorder. This condition can be cured by endoscopic surgery.

To investigate the clinical characteristics of patients with prolonged menstruation treated with hysteroscopic resection of a cesarean scar defect (CSD), and to analyze the high-risk factors for its coexistence with intrauterine pathologies, such as endometrial polyps or endometrial hyperplasia. This retrospective cohort study included 382 patients with prolonged menstruation who underwent CSD resection between January 2023 and December 2024. Based on the presence or absence of concurrent endometrial polyps or hyperplasia, the patients were divided into two groups: the simple CSD group (n=208) and the group with coexisting endometrial pathology (n=174). The definition of endometrial lesions was based on imaging and pathological examination findings, and all diagnoses were made by experienced physicians. Differences in demographics, clinical presentation, imaging parameters, and menstrual improvement were compared. Logistic regression was used to identify independent risk factors for endometrial lesions and develop a predictive model with a nomogram. Compared with the simple CSD group, patients with coexisting endometrial disease had a higher rate of anemia (33.9% vs 17.3%, p<0.001), lower preoperative medication use (14.9% vs 27.9%, p=0.002), lower preoperative hemoglobin (p<0.001), thicker endometrium (8.4 vs 6.7 mm, p<0.001), slightly larger CSD dimensions, and higher rates of CSD-related cysts and fibroids (all p<0.05). Multivariate analysis identified anemia, lack of preoperative medication, endometrial thickness, and CSD-related cysts as independent predictors. The constructed prediction model showed moderate discrimination with an AUC of 0.710. Menstrual improvement at 6 months postoperatively was comparable between the two groups. Patients with CSD and coexisting endometrial lesions present with more complex intrauterine features and a higher risk of abnormal bleeding. Despite similar short-term outcomes, preoperative identification of endometrial pathology is essential for optimizing treatment strategies and individualized intervention.

This retrospective cohort study aimed to compare the clinical outcomes of patients with cesarean scar defect (CSD) undergoing frozen embryo transfer (FET) with or without hysteroscopic repair surgery. The study included 82 patients, with 48 patients in surgical group A (undergoing CSD repair) and 34 patients in surgical group B (undergoing hysteroscopic treatment for other uterine lesions). The results showed that patients in group A had a larger CSD volume and a different shape compared to group B. However, there was no significant difference in clinical pregnancy rates between the two groups. Additionally, there were no differences in miscarriage, live birth, or preterm birth rates, and no complications such as scar pregnancy or placental abnormalities were observed in either group. These findings suggest that hysteroscopic treatment of CSD in symptomatic patients undergoing FET does not increase the risk of pregnancy complications and can lead to comparable clinical pregnancy rates with asymptomatic patients. Further studies with larger sample sizes are needed to confirm these results and evaluate long-term reproductive outcomes following CSD repair.

Objective This meta-analysis aimed to evaluate the effects of hysteroscopic surgery combined with progesterone therapy on fertility and prognosis in patients with early endometrial cancer (EC), atypical endometrial hyperplasia (AEH), or endometrial intraepithelial neoplasia (EIN). Methods Studies on hysteroscopic surgery combined with progesterone therapy for patients with early-stage EC, AEH, or EIN were searched from Embase, Web of Science, PubMed, and Cochrane Library databases. The included studies contained one or more of the following outcome variables: pregnancy rate, live birth rate, complete response (CR) rate, and recurrence rate after conservative treatment. The meta-analysis was performed using Stata. Results 13 pieces of literature containing 239 patients with EC and 199 patients with AEH/EIN were included. As per the results of meta-analysis, the pregnancy rates of EC patients and AEH/EIN patients were 49% (95% CI 33–65%) and 47% (95% CI 31–64%), respectively, and the live birth rates were 45% (95% CI 32–58%) and 44% (95% CI 34–54%), respectively. CR rates of EC patients and AEH/EIN patients were 90% (95% CI 85–94%) and 100% (95% CI 97–100%), respectively, and the disease recurrence rates were 17% (95% CI 8–28%) and 11% (95% CI 3–23%), respectively. Conclusion Hysteroscopic surgery combined with progesterone was linked to an improved overall response rate, reduced disease recurrence rate, and increased pregnancy and live birth rates among patients with EC and AEH/EIN.

Perioperative prophylactic antimicrobial use for hysteroscopic surgery is suboptimal, even with guidelines and official policies in place. This study aimed to assess the role of clinical pharmacists in the management of perioperative prophylactic antimicrobial therapy in hysteroscopic surgery and to analyze its impact on clinical outcomes and cost-effectiveness. This retrospective study reviewed hysteroscopic surgery cases at a tertiary-level Class A hospital from September to December 2022 and September to December 2023. The cases were divided into routine and intervention groups on the basis of the involvement of clinical pharmacists. The primary outcomes assessed included the rational use of antimicrobial drugs, postoperative infections, and economic benefits. To control for confounding factors, a 1:1 propensity score matching method was applied. A total of 849 patients were included in this study, with 226 patients in each group after propensity score matching. Significant differences were observed between the conventional and intervention groups in several areas: unreasonable timing of preoperative drug administration (22.7% vs 0%, p < 0.001), prolonged duration of prophylaxis (32.6% vs 11.5%, p = 0.029), unindicated prophylaxis (69% vs 28.8%, p < 0.001), and inappropriate dosing regimens (61.5% vs 14.6%, p < 0.001). In terms of economic benefits, the intervention group showed a significant reduction in the length of hospitalization (3.15 vs 2.15 days, p < 0.001). Additionally, significant differences were found in the costs of patient medications ($53.17 vs $42.66, p < 0.001) and antimicrobials ($8.16 vs $2.18, p < 0.001). Clinical pharmacist interventions can significantly enhance the rational use of perioperative antimicrobial drugs in hysteroscopic surgery, leading to notable clinical outcomes and economic benefits.

This study aimed to investigate the impact of different doses of oliceridine on the ED of esketamine during hysteroscopic surgery. The objective was to establish an optimal dosing regimen that facilitates the development of an effective and safe analgesic strategy for this procedure by leveraging the potential synergistic effects between the two drugs. The trial was conducted involving 90 patients scheduled for elective hysteroscopy. Participants were allocated into three groups: control (0 mg oliceridine), group O1 (1 mg oliceridine), and group O2 (2 mg oliceridine). Anesthesia was induced with propofol, followed by a continuous infusion of propofol and a preset dose of esketamine. The primary outcome was the ED of esketamine, determined using Dixon's up-and-down method. Secondary outcomes included recovery time, hemodynamic parameters, pain and sedation scores, and the incidence of adverse events. The ED of esketamine was 0.76(0.66-0.86), 0.45(0.40-0.55), and 0.41 (0.31-0.59) mg/kg/h in the control, group O1 and O2, respectively. Compared with the control, group O1( = 0.020) and O2( = 0.001) showed significantly shorter recovery time. Hemodynamic stability was comparable across groups, though the effect on HR was observed: bradycardia incidence was higher in group O1 than in the Control ( = 0.021) but lower in group O2 than in O1( = 0.004). Compared to the control, the O1 and O2 groups showed a significantly reduced incidence of both excessive oral secretion (3.7% in group O2 vs. 0.0% in group O1 vs. 32.0% in control, = 0.000) and cough (4.3% in group O1 and 0.0% in group O2 vs. 28.0% in the control, = 0.002). The combination therapy did not increase respiratory adverse reactions ( > 0.05), and the 2 mg of oliceridine appeared to provide optimal balance between efficacy and safety within the limits of this study. For hysteroscopic procedures, the co-administration of oliceridine was associated with a lower ED of esketamine. This regimen provided synergistic analgesia, reducing the ED of esketamine to lower deep sedation and accelerate recovery. Furthermore, it improved hemodynamic stability by lowering bradycardia incidence without augmenting respiratory adverse effects. www.chictr.org.cn, (ChiCTR2500101056); registration date: April 18, 2025.

ObjectiveThis study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD).MethodsTwenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months.ResultsThe median follow-up time is 85 months (range, 30–114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8–117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease.ConclusionsAfter a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.

Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective contraceptive and non-surgical treatment for various gynecological conditions. However, its high expulsion rate remains a concern, particularly in women with a history of prior expulsion. This study aimed to evaluate the effectiveness of non-absorbable suture fixation under hysteroscopic guidance to reduce expulsion rates. Methods: A total of 73 women with a history of LNG-IUS expulsion were enrolled between August 2022 and August 2023 at the Women's Hospital, Zhejiang University School of Medicine. All participants underwent hysteroscopic suture fixation of the LNG-IUS. Postoperative assessments were conducted on days 1, 3, and 7 using electronic questionnaires, along with outpatient follow-up and ultrasonography at 1, 3, and 6 months. Results: All 73 procedures were successfully performed as outpatient (day) surgeries, with a mean duration 37.81 ± 14.90 min, without encountering any complications. Follow-up was conducted for all 73 patients at 6 months, with 70 patients undergoing postoperative imaging, primarily using ultrasonography. Low rates of expulsion (4.29%) and downward-shift (7.14%) were observed. Decreased menstrual bleeding or amenorrhea was reported by 68 patients (93.15%). Among the 47 patients with preoperative dysmenorrhea, complete symptom relief was achieved in 39 cases (82.97%). Conclusions: In patients with a history of LNG-IUS expulsion, hysteroscopic suture fixation of the LNG-IUS not only lowers the rate of re-expulsion but also alleviates associated symptoms.