The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 555-569 , September 2010

Review of Intrauterine Adhesions

  • Rebecca Deans, MBBS, MRANZCOG
  • ,
  • Jason Abbott, B MED (Hons), MRCOG, FRANZCOG, PhD

      Affiliations

    • Corresponding Author InformationCorresponding author: Jason Abbott, MB, BS, Royal Hospital for Women, University of New South Wales, Barker St, Randwick, 2031 New South Wales, Australia.

Received 18 December 2009 ,Accepted 30 April 2010.

References 

  1. Fritsh H. Ein Fall von volligem Schwund ser Gebarmutterhohle nach Auskratzung. Zentralbl Gynaekol. 1894;18:1337–1342
  2. Asherman JG. Traumatic intra-uterine adhesions. Br J Obstet Gynaecol. 1950;57:892–896
  3. Yu D, Wong Y-M, Cheong Y, Xia E, Li T-C. Asherman syndrome: one century later. Fertil Steril. 2008;89:759–779
  4. Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril. 1982;37:593–610
  5. Al-Inany H. Intrauterine adhesions: an update. Acta Obstet Gynecol Scand. 2001;80:986–993
  6. Foix A, Bruno R, Davison T, Baltasar L. The pathology of postcurettage adhesions. Am J Obstet Gynecol. 1966;96:1027–1033
  7. Yaffe H, Ron M, Polishuk W. Amenorrhoea, hypomenorrhoea and uterine fibrosis. Am J Obstet Gynecol. 1978;130:599–601
  8. McCulloch T, Wagner B, Duffy S, Barik S, Smith J. The pathology of hysterectomy specimens following trans-cervical resection of the endometrium. Histopathology. 1995;27:541–547
  9. Tam WH, Lau WC, Cheung LP, Yuen PM, Chung TK-H. Intrauterine adhesions after conservative and surgical management of spontaneous abortion. J Am Assoc Gynecol Laparosc. 2002;9:182–185
  10. Dmowski WP, Greenblatt R. Asherman's syndrome and risk of placenta accreta. Obstet Gynecol. 1969;34:288–299
  11. Kodaman PH, Arici A. Intra-uterine adhesions and fertility outcome: how to optimize success?. Curr Opin Obstet Gynecol. 2007;19:207–214
  12. Rabau E, David A. Intrauterine adhesions: etiology, prevention, and treatment. Obstet Gynecol. 1963;22:626–629
  13. Toaff R, Ballas S. Traumatic hypomenorrhea-amenorrhea (Asherman's syndrome). Fertil Steril. 1978;30:379–387
  14. Ventolini G, Zhang M, Gruber J. Hysteroscopy in the evaluation of patients with recurrent pregnancy loss. Surg Endosc. 2004;18:1782–1784
  15. Polishuk W, Kohane S. Intrauterine adhesions: diagnosis and therapy. Obstet Gynecol Digest. 1966;8:41
  16. Westendorp ICD, Ankum WM, Mol B, Vonk J. Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod. 1998;13:3347–3350
  17. Rochet Y, Dargent D, Bremond A. The obetetrical outcome of women with surgically treated uterine synechiae. J Gynecol Obstet Biol Reprod. 1979;8:723–726
  18. Parent B, Barbot J, Dubuisson J. Uterine synechiae. Encycl Med Chir Gynecol. 1988;140A(suppl):10–12
  19. Eriksen J, Kaestel C. The incidence of uterine atresia after post-partum curettage: a follow-up examination of 141 patients. Dan Med Bull. 1960;7:50
  20. Jones WE. Traumatic intrauterine adhesions. Am J Obstet Gynecol. 1964;89:304–313
  21. Fedele L, Vercellini P, Viezzoli T, Ricciardiello O, Zamberleti D. Intrauterine adhesions: current diagnostic and therapeutic trends. Acta Eur Fertil. 1986;17:31–37
  22. Friedler S, Margalioth EJ, Kafka I, Yaffe H. Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy: a prospective study. Hum Reprod. 1993;8:442–444
  23. Taskin O, Sadik S, Onoglu A, et al. Role of endometrial supression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc. 2000;7:351–354
  24. Netter AP, Musset R, Lambert A, Salomon Y. Traumatic uterine synechiae: a common cause of menstrual insufficiency, sterility, and abortion. Am J Obstet Gynecol. 1956;71:368–375
  25. Davies C, Gibson M, Holt E, Torrie E. Amenorrhoea secondary to endometrial ablation and Asherman's syndrome following uterine artery embolization. Clin Radiol. 2002;57:317–318
  26. Roman H, Sentilhes L, Cingotti M, Verspyck E, Marpeau L. Uterine devascularization and subsequent major intrauterine synechiae and ovarian failure. Fertil Steril. 2005;83:755–757
  27. Jensen P, Stromme W. Amenorrhoea secondary to peurperal curettage (Asherman syndrome). Am J Obstet Gynecol. 1972;113:150
  28. Polishuk WZ, Siew FP, Gordon R, Lebenshart P. Vascular changes in traumatic amenorrhea and hypomenorrhea. Int J Fertil. 1977;22:189–192
  29. [No authors listed] The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–955
  30. Smid A, Borsos A, Takacs I. Etiology of Asherman's syndrome (intrauterine synechiae). Zentralbl Gynaekol. 1980;102:380–385
  31. Shaffer W. Role of intrauterine adheisions in the case of multiple pregnancy losses. Clin Obstet Gynecol. 1986;29:912–924
  32. Carp HJ, Ben-Shlomo I, Mashiach S. What is the minimal uterine cavity needed for a normal pregnancy? an extreme case of Asherman syndrome. Fertil Steril. 1992;58:419–421
  33. Taylor PJ, Cumming DC, Hill PJ. Significance of intrauterine adhesions detected hysteroscopically in eumenorrheic infertile women and role of antecedent curettage in their formation. Am J Obstet Gynecol. 1981;139:239–242
  34. March C, Israel R, March A. Hysteroscopic managment of intrauterine adhesions. Am J Obstet Gynecol. 1978;130:653–657
  35. Magos A. Hysteroscopic treatment of Asherman's syndrome. Reprod Biomed Online. 2002;4(suppl 3):46–51
  36. Kremer C, Duffy S, Moroney M. Patient satisfaction with outpatient hysteroscopy versus day case hysteroscopy: randomised controlled trial. BMJ. 2000;320:279–282
  37. Demirol A, Gurgan T. Effect of treatment of intrauterine pathologies with office hysteroscopy in patients with recurrent IVF failure. Reprod Biomed Online. 2004;8:590–594
  38. Wamsteker K, Blok SD. Diagnostic hysteroscopy: technique and documentation. In:  Sutton C,  Diamond M editor. Endoscopic Surgery for Gynecologists. Philadelphia, PA: WB Saunders; 1993;
  39. Roma DA, Ubeda B, Ubeda A, et al. Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy. AJR. 2004;183:1405–1409
  40. Soares SR, Barbosa dos Reis MMB, Carnargos AF. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril. 2000;73:406–410
  41. Raziel A, Arieli S, Bukovsky I, Caspi E, Golan A. Investigation of the uterine cavity in recurrent aborters. Fertil Steril. 1994;62:1080–1082
  42. Confino E, Friberg J, Giglia R, Gleicher N. Sonographic imaging of intrauterine adhesions. Obstet Gynecol. 1985;66:596–598
  43. Schlaff WD, Hurst BS. Preoperative sonographic measurement of endometrial pattern predicts outcome of surgical repair in patients with severe Asherman's syndrome. Fertil Steril. 1995;63:410–413
  44. Salle B, Gaucherand P, de Saint Hilaire P, Rudigos RC. Transvaginal sonohysterographic evaluation of intrauterine adhesions. J Clin Ultrasound. 1999;27:131–134
  45. Sylvestre C, Child T, Tulandi T, Tan S. A prospective study to evaluate the efficacy of two and three dimensional sonohysterography in women with intrauterine adhesions. Fertil Steril. 2003;79:1222–1225
  46. Weinraub Z, Maymon R, Shulman A, et al. Three dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology. Ultrasound Obstet Gynecol. 1996;8:277–282
  47. Makris N, Kalmantis K, Skartados N, Papadimitriou A, Mantzaris G, Antsaklis A. Three-dimensional hysterosonography versus hysteroscopy for the detection of intracavitary uterine abnormalities. Int J Gynecol Obstet. 2007;97:6–9
  48. Dykes T, Isler R, McLean A. MR imaging of Asherman syndrome: total endometrial obliteration. J Comput Assist Tomogr. 1991;15:858–860
  49. Letterie G, Haggerty M. Magnetic resonance imaging of intruterine synechiae. Gynecol Obstet Invest. 1994;37:66–68
  50. Bacelar AC, Wilcock D, Powell M, Worthington BS. The value of MRI in the assessment of traumatic intra-uterine adhesions (Asherman's syndrome). Clin Radiol. 1995;50:80–83
  51. Hamou J, Salat-Baroux J, Siegler A. Diagnosis and treatment of intrauterine adhesions by microhysteroscopy. Fertil Steril. 1983;39:321–326
  52. Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158:1459–1470
  53. Wamsteker K, De Block S. Diagnostic hysteroscopy: technique and documentation. In:  Sutton C,  Diamond M editor. Endoscopic surgery for gynecologists. London: WB Saunders; 1998;p. 511–524
  54. Nasr A, Al-Inany H, Thabet S, Aboulghar M. A clinicohysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Invest. 2000;50:178–181
  55. Donnez J, Nisolle M. Hysteroscopic adheisolysis of intrauterine adhesions (Asherman syndrome). In:  Donnez J editors. Atlas of Laser Operative Laparoscopy and Hysteroscopy. London, England: Parthenon Publishing Group; 1994;p. 305–322
  56. Asherman JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Empire. 1948;55:23–30
  57. Sugimoto O. Diagnostic and therapeutic hysterosocpy for traumatic intrauterine adheisons. Am J Obstet Gynecol. 1978;131:539–547
  58. Broome JD, Vancaille T. Fluroscopically guided hysteroscopic division of adhesions in severe Asherman syndrome. Obstet Gynecol. 1999;93:1041–1043
  59. Thomson A, Abbott J, Kingston A, Lenart M, Vancaille T. Fluoroscopically guided synechiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes. Fertil Steril. 2007;87:405–410
  60. Goldenberg M, Schiff E, Achiron R, Lipitz S, Mashiach S. Managing residual trophoblastic tissue: hysteroscopy for directing curettage. J Reprod Med. 1997;42:26–28
  61. Capella-Allouc S, Morsad F, Rongieres-Bertrand C, Taylor S, Fernandez H. Hysteroscopic treatment of severe Asherman's syndrome and subsequent fertility. Hum Reprod. 1999;14:1230–1233
  62. Chapman R, Chapman K. The value of two stage laser treatment for severe Asherman's syndrome. Br J Obstet Gynaecol. 1996;103:1256–1258
  63. Pabuccu R, Atay V, Orhon E, Urman B, Ergiin A. Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility. Fertil Steril. 1997;68:1141–1143
  64. Duffy S, Reid P, Sharp F. In-vivo studies of uterine electrosurgery. Br J Obstet Gynaecol. 1992;99:579–582
  65. Roge P, D'Ercole C, Cravello L, Boubli L, Blanc B. Hysteroscopic management of uterine synechiae: a series of 102 observations. Eur J Obstet Gynecol Reprod Biol. 1996;65:189–193
  66. Fernandez H, Gervaise A, de Tayrac R. Operative hysteroscopy for infertility using normal saline solution and a coaxial bipolar electrode: a pilot study. Hum Reprod. 2000;15:1773–1775
  67. Zikopoulos K. Live delivery rates in subfertile women with Asherman's syndrome after hysteroscopic adhesiolysis using the resectoscope or the Versapoint system. Reprod Biomed Online. 2004;8:720–725
  68. Newton JR, MacKenzie WE, Emens MJ, Jordan JA. Division of uterine adhesions (Asherman syndrome) with Nd-YAG laser. Br J Obstet Gynaecol. 1989;96:102–104
  69. Chen F, Soong YK, Hui YL. Successful treatment of severe uterine synechiae with transcervical resectoscopy combined with laminara tent. Hum Reprod. 1997;12:943–947
  70. Coccia ME, Becattini C, Bracco GL, Pampaloni F, Bargelli G, Scarselli G. Pressure lavage under ultrasound guidance: a new approach for outpatient treatment of intrauterine adhesions. Fertil Steril. 2001;75:601–606
  71. Protopapas A, Shushan A, Magos A. Myometrial scoring: a new technique for the management of severe Asherman's syndrome. Fertil Steril. 1998;69:860–864
  72. McComb PF, Wagner BL. Simplified therapy for Asherman's syndrome. Fertil Steril. 1997;68:1047–1050
  73. Karande V, Levrant S, Hoxsey R, Rinehart J, Gleicher N. Lysis of intrauterine adhesions using gynecoradiologic techniques. Fertil Steril. 1997;68:658–672
  74. Fraser IS, Song JY, Jansen RPS, Ramsay P. Hysteroscopic lysis of intra-uterine adhesions under ultrasound guidance. Gynaecol Endosc. 1995;4:35–40
  75. Bellingham R. Intrauterine adhesions: hysteroscopic lysis and adjunctive methods. Aust NZ J Obstet Gynaecol. 1996;36:171–174
  76. Hayasaka S, Murakami T, Arai M, et al. A method for safe hysteroscopic synechiolysis in patients with Asherman syndrome. J Gynecol Surg. 2009;25:147–152
  77. Tiras M, Oktem M, Noyan V. Laparoscopic intracorporal ultrasound guidance during hysteroscopic adhesiolysis. Eur J Obstet Gynecol Reprod Biol. 2003;108:80–84
  78. Wolff F. Verwachsungen in der Cervix Uteri nach Curettagen. Zentralbl Gynaekol. 1926;50:1247
  79. Bukulmez O, Yarali H, Gurgan T. Total corporal synechiae due to tuberculosis carry a very poor prognosis following hysteroscopic synechiolysis. Hum Reprod. 1999;14:1960
  80. Preutthipan S, Linasmita V. A prospective comparitive study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J Obstet Gynaecol Res. 2003;29:33–37
  81. Pabuccu R, Onalan G, Kaya C, et al. Efficiency and pregnancy outcome of serial intrauterine device–guided hysteroscopic adhesiolysis of intrauterine synechiae. Fertil Steril. 2008;90:1973–1977
  82. Ismajovich B, Lidor A, Confino E, David MP. Treatment of minimal and moderate intrauterine adhesions (Asherman's syndrome). J Reprod Med. 1985;30:769–772
  83. Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Reproductive outcome following hysteroscopic adhesiolysis in Asherman syndrome. Int J Fertil Menopausal Stud. 1996;41:462–465
  84. Yasmin H, Nasir A, Noorani KJ. Hysteroscopic management of Asherman's syndrome. J Pak Med Assoc. 2007;57:553–555
  85. Orhue AAE, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynecol Obstet. 2003;82:49–56
  86. Vesce F, Jorizzo G, Bianciotto A, Gotti G. Use of intrauterine device in the management of secondary amenorrhea. Fertil Steril. 2000;73:162–165
  87. March C. Gestational outcomes following hysteroscopic lysis of adhesions. Fertil Steril. 1981;36:455–459
  88. San Fillipo J, Fitzgerald D. Asherman's syndrome: a comparison of therapeutic methods. J Reprod Med. 1982;27:328–330
  89. Amer M, El Nadim A, Hassanein K. The role of intrauterine balloon after operative hysteroscopy in the prevention of intrauterine adhesion: a prospective controlled study. MEFS J. 2005;10:125–129
  90. Amer M, Abd-El-Maebou KH. Amnion graft following hysteroscopic lysis of intrauterine adhesions. J Obstet Gynaecol Res. 2006;32:559–566
  91. Tsapanos VS, Stathopoulou LP, Papathanassopoulou VS, Tzingounis VA. The role of Seprafilm bioresorbable membrane in the prevention and therapy of endometrial Synechiae. J Biomed Mater Res. 2001;63:10–14
  92. Accunzo G, Guida M, Pellicano M, Tommaselli G, DiSpiezio SA. Bifulco Gea. Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a prospective randomized, controlled study. Hum Reprod. 2003;18:1918–1921
  93. Guida M, Acunzo G, Sardo ADS, et al. Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod. 2004;19:1461–1464
  94. Burns J, Skinner K, Colt J, et al. Prevention of tissue injury and postsurgical adhesions by precoating tissues with hyaluronic acid solutions. J Surg Res. 1995;59:644–652
  95. De Laco PA, Stefanetti M, Pressato D, et al. A novel hyaluronan-based gel in laparoscopic adhesion prevention: preclinical evaluation in an animal model. Fertil Steril. 1998;69:318–323
  96. Mensitieri M, Ambrosio L, Nicolaris L, Bellini D, O'Reaan M. Visco-elastic properties modulation of a novel auto-cross-linked haluronic acid polymer. J Mater Sci Mater Med. 1996;7:695–698
  97. Wood J, Pena G. Treatment of traumatic uterine synechias. Int J Fertil. 1964;9:405–410
  98. Farhi J, Bar-Hava I, Homburg R, Dicker D, Ben-Rafael Z. Induced regeneration of endometrium following curettage for abortion: a comparative study. Hum Reprod. 1993;8:1143
  99. Hurst BS, Bhojwani J, Marshburn P. Low dose asprin does not improve ovarian stimulation, endometrial response or pregnancy rates for invitro fertilization. J Exp Clin Assist Reprod. 2005;31:8–13
  100. Hsieh Y, Tsai H, Chang C. Low dose asprin for infertile women with thin endometrium receiving intra-uterine insemination: a prospective, randomized study. J Assist Reprod Genet. 2000;17:174–177
  101. Zackrisson U, Brannstrom M, Granberg S. Acute effects of a transdermal nitric oxide donor on perifollicular and intrauterine blood flow. Ultrasound Obstet Gynecol. 1998;12:50–55
  102. Sher G, Fisch D. Effect of vaginal sidenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Hum Reprod. 2001;15:806–809
  103. Zinger M, Liu J, Thomas M. Successful use of vaginal sildenafil citrate in two infertility patients with Asherman syndrome. J Women Health. 2006;442–444
  104. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 74. Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2006;108:225–234
  105. Siegler A, Valle R. Therapeutic hysterosocpic procedures. Fertil Steril. 1988;50:685–701
  106. Fernandez H, Fadheela A-N. Fertility after treatment of Asherman's syndrome. J Minim Invasive Gynecol. 2006;13:398–402
  107. Robinson JK, Swedarsky Colimon LM, Isaacson KB. Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman's syndrome). Fertil Steril. 2008;90:409–414
  108. Feng Z, Yang B, Shao J, Liu S. Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesions after induced abortions: clinical analysis of 365 cases. Gynaecol Endosc. 1999;8:95–98
  109. Neuwirth R, Hussein A, Schiffman B, Amin HK. Hysterosocpic resection of intrauterine scars using a new technique. Obstet Gynecol. 1982;60:111–113
  110. Wamsteker K. Hysteroscopy in the management of abnormal bleeding in 199 patients. In:  Seiger AM,  Lindemann HJ editor. Hysteroscopy Principles and Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 1984;
  111. Deaton J, Maier D, Andreoli JJ. Spontaneous uterine rupture during pregnancy after treatment of Asherman's syndrome. Am J Obstet Gynecol. 1989;160:1053
  112. Hulka J. Uterine rupture after treatment of Asherman's syndrome. Am J Obstet Gynecol. 1990;162:1352–1353
  113. Carp H, Tode V, Mashiach S. Efficacy of immunotherapy preceding in vitro fertilization and embryo transfer. Fertil Steril. 1992;57:445–447
  114. Barbot J. Traitement chirurgical et endoscopue des synecnies uterines. In: Anonymous  editors. Techniques chir Urologie-Gynecologie. Paris: Editions Techniques; 1994;
  115. Goldberg M, Sivan E, Sharabi Z, Mashiach S, Lipitz S, Seidman D. Reproductive outcome following managment of intrauteirne septum and adhesions. Hum Reprod. 1995;10:2663–2665
  116. Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Reproductive outcome following hysteroscopic adhesiolysis in Asherman syndrome. Int J Fertil Menopausal Stud. 1996;41:462–546
  117. Pistofidis G, Dimitropoulos K, Mastrominas M. Comparison of operative and fertility outcome between groups of women with intrauteirne adhesions after adhesiolysis. J Am Assoc Gynecol Laparosc. 1996;3(suppl):S40
  118. Villos G. Intrauterine surgery using a new coaxial bipolar electrode in normal saline solution (Versapoint): a pilot study. Fertil Steril. 1999;72:740–743
  119. Shiau C, Hseih C, Chiang C, Hseih T, Chang M. Intrapartum spontaneous treatment of Asherman's syndrome. Chang Gung Med J. 2005;28:123–127
  120. Taniguchi F, Suginami H. Pregnancy and delivery following sonohysterographic lysis to treat recurrence after hysteroscopic lysis of severe intrauterine adhesions: a case report. Clin Exp Obstet Gynecol. 2008;35:215–217
  121. Yu D, Li T, Xia E, Huang X, Liu Y, Peng X. Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome. Fertil Steril. 2008;89:715–722
  122. Friedman A, DeFazio J, DeCherney A. Severe obstetric complications after aggresive treatment of Asherman syndrome. Obstet Gynecol. 1986;67:864–867
  123. World Health Organisation Task Force on Post-ovulatory Methods for Fertility Regulation. Menstrual regulation by intramuscular injections of 16-phenoxy-tetranor PGE2 methly sulfonylamide or vacuum aspiration: a randomized multicentre study. Br J Obstet Gynaecol. 1987;94:949–956
  124. Wolman I, Gordon D, Yaron Y, Kupferminic M, Lessing J, Jaffa A. Transvaginal sonohysterography for the evaluation and treatment of retained products of conception. Gynecol Obstet Invest. 2000;50:73–76
  125. Alcazar J. Transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler to detect residual trophoblastic tissue. Ultrasound Obstet Gynecol. 1998;11:54–58
  126. American Academy of Gynecologic Laparoscopists. Advancing mininmally invasive gynecology worldwide. AAGL Practice report: practice guidleines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010;17:1–7

 The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

PII: S1553-4650(10)00237-2

doi: 10.1016/j.jmig.2010.04.016

The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 555-569 , September 2010