An Innovative Surgical Technique: Anchoring Levonorgestrel-Releasing Intrauterine System Using a Specialized Fixation Needle

Background: Numerous surgical techniques have been proposed to enhance the stability of intrauterine system (IUS) and reduce the incidence of displacement and expulsion, however, challenges remain. We aim to explore improved therapeutic strategies for levonorgestrel-releasing intrauterine system (LNG-IUS) displacement or expulsion cases. Methods: This study proposes a novel method utilizing a specialized fixation needle to anchor the Mirena intrauterine device (IUD) within the uterine muscle layer. From June 2022 to December 2022, patients underwent hysteroscopic suturing for Mirena fixation, serving as the control group. From January 2023 to June 2023, 38 patients underwent hysteroscopic anchoring of Mirena using a specialized fixation needle, constituting the experimental group. Results: A total of 59 patients were included in the study. The experimental group included 38 patients, aged 31 to 51 years, with a median age of 41.5 (interquartile range: 36, 46) years. Comparison of treatment outcomes between the two groups showed significant improvements in Visual Analog Scale (VAS) scores, Pictorial Blood Assessment Chart (PBAC) scores, and hemoglobin (Hb) levels after treatment in both the experimental and control groups (all p < 0.001). Moreover, in the control group, 90.48% (19/21) of patients had normal contraceptive device positions during postoperative follow-up. In the control group, 2 patients (9.52%) experienced IUD displacement postoperatively. While, in the experimental group, 97.37% (37/38) of patients had normal contraceptive device positions during postoperative follow-up. However, 2.63% (1/38) experienced sudden excessive menstrual bleeding and IUD expulsion at 3 months postoperatively, requiring total hysterectomy. Conclusions: Hysteroscopic anchoring of the LNG-IUSs using a specialized fixation needle addresses the issue of device expulsion, offering a more straightforward and accessible alternative to traditional hysteroscopic suturing methods. Moreover, similar to hysteroscopic suturing of Mirena, this technique effectively relieves dysmenorrhea and heavy menstrual bleeding symptoms in patients.