{
  "abstract": "Background/Objectives: Blind mechanical dilatation is the conventional response to a cervix that cannot be negotiated during operative hysteroscopy and is often implicated in perforation. We evaluated a graded, vision-controlled strategy for difficult cervical access. Methods: Retrospective single-surgeon cohort of 973 eligible no-touch vaginoscopic operative hysteroscopies (2023–2026) using a 7.25 mm mechanical tissue removal system. Each difficult cervix was graded 1–4 from first-approach morphology; four escalating vision-controlled techniques were selected intraoperatively, not by grade, with blind dilatation as rescue. The primary outcome was uterine access. Results: Difficult access occurred in 139 procedures (14.3%). Access was achieved in all 128 grade 1–3 patients (100%, 95% CI 97.2–100) and in 5 of 11 with grade 4 (45.5%, 16.7–76.6); overall 133/139 (95.7%, 90.8–98.4). Among successful passages, cervical passage time increased across grades (medians 37, 101, 170 and 240 s; p < 0.001); operation time did not (p = 0.11). Perforation occurred in five patients (3.6%): one during vision-controlled passage and four during blind rescue dilatation after failed grade 4 attempts; all were managed conservatively. Conclusions: Vision-controlled passage achieved access without blind dilatation in every cervix not completely obliterated; complete obstruction remains its limit. The grading and techniques require prospective, multicentre and interobserver validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Obstetrics and Gynecology, Diyarbakır Gazi Yaşargil Training and Research Hospital, 21070 Diyarbakır, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Cihan Bademkiran",
      "orcid": "0000-0002-1791-7523"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b30nv1r7cwtg6.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15228793",
  "fulltext_url": null,
  "id": "b30nv1r7cwtg6",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/22/8793",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-10",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/b30nv1r7cwtg6.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T00:21:49Z",
      "native_id": "10.3390/jcm15228793",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/22/8793"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Graded, Vision-Controlled Access to the Difficult Cervix During Operative Hysteroscopy: Development and Preliminary Evaluation in 973 Procedures",
  "title_text": "Graded, Vision-Controlled Access to the Difficult Cervix During Operative Hysteroscopy: Development and Preliminary Evaluation in 973 Procedures",
  "type": "peer-reviewed",
  "updated_at": "2026-11-12T00:20:57Z",
  "url": "https://research.draconitic.com/paper/b30nv1r7cwtg6",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}