Combined Hysteroscopic Findings and 3-Dimensional Reconstructed Coronal View of the Uterus To Avoid Laparoscopic Assessment for Inpatient Hysteroscopic Metroplasty: Pilot Study

Study Objective: To assess the use of 3-dimensional (3D) reconstructed coronal view of the uterus and intraoperative hysteroscopic findings to avoid diagnostic laparoscopy during inpatient hysteroscopic metroplasty.Design: Pilot study (Canadian Task Force classification II).Setting: University hospital infertility clinic.Patients: Fifty-nine patients with recurrent abortion and double uterine cavity with 3D sonographic diagnosis of septate uterus undergoing inpatient hysteroscopic metroplasty.Interventions: Inpatient hysteroscopic treatment of septate uterus without laparoscopic diagnosis. In addition to sonographic observations, 2 intraoperative hysteroscopic criteria were used to confirm the diagnosis: visualization of muscular fibers and myometrial blood vessels.Measurements and Main Results: Operative parameters (operative time and fluid absorption), complications (incomplete resection and uterine perforation), requirement for a second intervention, and shape of the uterine cavity at hysteroscopic follow-up. In 56 of 59 patients (94.9%), intervention was performed without complications, and in 3 cases, intervention was suspended because of intraoperative suspicion of bicornate uterus. These 3 patients underwent laparoscopy, which confirmed the diagnosis of septate uterus. In all cases, incision was considered sufficient. Postoperative diagnostic hysteroscopy in all patients showed a normal cavity (fundal notch <1 cm).Conclusions: Combined use of hysteroscopic confirming criteria and 3D sonography seems to be a reliable and simple strategy for characterizing the presence of septate uterus and to perform inpatient metroplasty usually without laparoscopic visualization of the uterine fundus. Journal of Minimally Invasive Gynecology (2011) 18, 112-117 (C) 2011 AAGL. All rights reserved.