Visual dilation and curettage for the fertility-sparing treatment of atypical endometrial hyperplasia/endometrial intra-epithelial neoplasia: an easy to perform in-office technique

Hysteroscopic endometrial resection when added to progestin therapy has been shown to improve the outcomes of fertilitysparing treatment in patients diagnosed with atypical endometrial hyperplasia/ endometrial intraepithelial neoplasia . 2 Unfortunately, with such a technique, the extension and depth of endometrium removal appears poorly reproducible. Moreover, the procedure must be performed in the operating room, and potential thermal damage of the specimen may affect its quality for histological examination. Hysteroscopic tissue removal systems have shown greater safety and better outcomes for the length of the procedure, the learning curve, and successful complete removal of benign intrauterine pathology compared with resectoscopes. However, further studies are needed to investigate the role of hysteroscopic tissue removal systems in patients with malignant pathology. Hysteroscopic procedures, when performed in the office/outpatient setting, are costeffective, with a low complication rate and high patient satisfaction. However, their use in the fertilitysparing treatment of atypical endometrial hyperplasia/endometrial intraepithelial neoplasia has never been described. The aim of this video article was to demonstrate the use of hysteroscopic tissue removal systems for the fertilitysparing treatment of patients with endometrial hyperplasia/endometrial intraepithelial neoplasia. We report the management of two women diagnosed with atypical endometrial hyperplasia/endometrial intraepithelial neoplasia who expressed the desire to preserve fertility. After counseling, women opted for fertilitysparing treatment of the disease.