Navigating False Passages: Strategies for Effective Hysteroscopy Management

Study Objective

Hysteroscopy represents the gold standard for diagnosing and treating intracavitary uterine pathology. It is rarely associated with complications, but 50% are related to uterine cavity entry. The false passage is correlated with early procedure termination or abortion. The objective is to educate about this pathology and to describe the different management techniques.

Design

This is a review of the literature on diagnosing and managing false passage and a video presentation of an innovative technique for hysteroscopic intracervical bridge division.

Setting

University-associated community hospital.

Patients or Participants

Two patients undergoing hysteroscopy were diagnosed with false passage.

Interventions

Diagnostic hysteroscopy, Hysteroscopic bridge division with scissors, hydrodissection, and tilt technique.

Measurements and Main Results

False passage was identified during diagnostic hysteroscopy in two patients. In the first case, characterized by an anteverted uterus, a posterior false passage was successfully managed using a combination of hydrodissection and the tilt technique. In the second case, featuring a retroverted uterus, an anterior false passage was effectively addressed through intracervical bridge division with hysteroscopic scissors. Notably, both procedures were completed as planned, showcasing the efficacy of the implemented techniques.

Conclusion

False passage during cervical dilation poses multifactorial challenges, potentially leading to premature procedure termination and concerns of uterine perforation. Mitigation and management of this complication require a systematic approach. Various techniques have been explored for its management, among which hysteroscopic division of the cervical bridge with scissors emerges as a practical and easily accessible strategy, offering promise in reducing early hysteroscopic termination and associated abortion rates.