Hysteroscopic approach to treat uterine malformations has been well defined more than 35 years ago. Colacurci and colleagues (1) wrote: “Hysteroscopic surgery replaced abdominal metroplasty and is today the treatment of choice for congenital uterine malformations”. Fayez J A (2) in 1986 stated that “…hysteroscopic metroplasty may be preferable to the transabdominal procedure based on cost and morbidity considerations as well as on anatomic and reproductive outcome…”. Candiani et al. in 1991 (3) demonstrated that “… microscissors are the simplest, fastest, most effective, and least expensive instrument to correct a septate uterus…”, because of the poor vascularized tissue of the intrauterine septum.
Sometimes the uterine malformation can be associated to a double vagina, due to the presence of a longitudinal vaginal septum The associated vaginal longitudinal septum cannot be treated just with microscissors as in the isolated intrauterine Mullerian defect due to its abundant vascularity, requiring an electrosurgical treatment to prevent unnecessary bleeding.
To our knowledge, no one before us has described the treatment of the longitudinal vaginal septum by means of an hysteroscopic resector…the following table, as published in our previous paper with R.Valle (4), shows two other reports about a similar technique, during the last decade of past century
The procedure, in each case, was easy, fast (it required no more than five minutes) and bloodless; the operative hysteroscope was introduced into the right hemivagina, and the resection started on the upper portion of the septum, not far from the uterine cervix. Once I penetrated into the left side, I completed the resection as in a standard hysteroscopic metroplasty, pushing the electrode towards the upper portion, than pulling and cutting in the direction of the external vaginal os.
The resection of the vaginal septum is perfect!
I recommend to use for this intervention the equatorial loop and not the handle of Collins.