A total endoscopic levonorgestrel-releasing intrauterine system (LNG-IUS) placement: a novel approach for obese patients with early-stage endometrial cancer.

Background: Endometrioid adenocarcinoma is a common endometrial cancer, linked to excess oestrogen exposure. Obesity, a major risk factor, can lead to unopposed oestrogen and endometrial cancer. Surgery is the standard treatment for early-stage disease. However, obese patients with a high body mass index (BMI) may be unsuitable due to surgical risks. Objectives: We present a novel completely endoscopic technique for placing a levonorgestrel-releasing intrauterine system (LNG-IUS) in an obese patient with early-stage endometrioid adenocarcinoma (FIGO 2009 stage IA, grade 1) who was not a surgical candidate due to multiple comorbidities. Participant: An 82-year-old obese woman (BMI: 48.9 kg/m Intervention: The LNG-IUS was successfully placed within the uterine cavity using a 5 mm XL Bettocchi hysteroscope and a 5 Fr grasping forceps, without needing vaginal speculum or cervical grasping. The patient tolerated the procedure well. Follow-up at six months was negative, without signs of recurrence. Conclusions: This case demonstrates the feasibility and safety of a total endoscopic LNG-IUS placement as an alternative for obese patients with early-stage endometrioid adenocarcinoma who are not surgical candidates. What is New?: This is the first description of a total endoscopic technique for LNG-IUS placement performed without speculum or anesthesia.