A Framework Approach for Hysteroscopic Uterine Septum Incision: Partial and Complete

Abstract

<h3>Study Objective</h3> To demonstrate safe and efficient techniques for hysteroscopic partial and complete uterine septum incision with electrocautery. <h3>Design</h3> Video instruction of hysteroscopic uterine septum incision techniques. <h3>Setting</h3> Academic hospital setting. <h3>Patients or Participants</h3> One patient with a partial uterine septum and one patient with a complete uterine septum. <h3>Interventions</h3> Hysteroscopic partial and complete uterine septum incision with the monopolar knife. <h3>Measurements and Main Results</h3> Surgical techniques that can be used to safely and efficiently incise a uterine septum and to determine when the incision is complete. For a partial uterine septum, these techniques include 1) alignment of the tubal ostia to maintain a horizontal incision plane, 2) uterine septum shortening, 3) uterine septum thinning, and 4) measurement of the residual septum length with the operating instrument to determine when the incision is complete. For a complete uterine septum, we additionally demonstrate how to make a window through the septum at the level of the internal os to incise the uterine portion while preserving the cervical portion inferiorly. <h3>Conclusion</h3> Uterine septum incision is typically a short procedure that can be successfully performed with operative hysteroscopy. However, if a systematic approach is not followed, the surgeon can quickly and unknowingly become disoriented which can lead to inadvertent uterine perforation, incomplete septum incision, or excessive septum incision causing myometrial thinning which has been shown to increase the risk of uterine rupture during pregnancy. The use of the techniques presented in this video help to maintain intra-operative orientation and provide a framework to guide adequate removal of the septum without causing injury to the myometrium. Review of these techniques may be particularly helpful for a surgical trainee or a less experienced hysteroscopic surgeon.