Three Degrees of Separation: Complete Uterine Septums

Abstract

Study Objective The goal of this video is to review how to diagnose and surgically manage three variations of incomplete Mullerian duct fusion and reabsorption. We focus on the differences between a complete septate uterus with a single septate cervix (unicollis), a septate uterus with duplicated cervix (bicollis), and a complete duplication of the uterus and cervix (uterine didelphis). Design N/A Setting All procedures were conducted at an academic medical center in the operating room setting. The patients were positioned in dorsal lithotomy with the legs supported using yellowfin stirrups. Patients or Participants Photos and video footage of three patients were collected during their respective surgeries in the operating room. Interventions We demonstrate the operative methods for safe vaginal, cervical and uterine septoplasty. In particular, we show different techniques that can be used for uterine/cervical septoplasty in the case of a complete septate uterus bicollis. We contrast this with the surgical management of a complete septate uterus unicollis. Measurements and Main Results N/A Conclusion This video explores the diagnosis and treatment of three Mullerian anomalies. Prior to surgical correction, it is essential to determine the specific type of anomaly. A complete septate uterus may be unicollis or bicollis; this is an important distinction due to their differing surgical management. In the case of a bicollis, we assert that it is best to avoid incision and repair of the two cervical canals due to the potential risk of cervical incompetence. A didelphys uterus does not require surgical intervention unless there is an accompanying symptomatic vaginal septum.