Usefulness and Safety of Hybrid Uterine Septal Dissection

Overview

Journal Gynecol Minim Invasive Ther

Date 2024 Dec 11

PMID 39660237

Authors

Shinichiro Saeki

Atsushi Fukui

Ayano Yamaya

Hiroaki Shibahara

Affiliations

Soon will be listed here.

Abstract

Objectives: The objective of this study was to investigate the safety and utility of hybrid uterine septal resection.

Materials And Methods: This retrospective cohort trial included 16 patients who underwent hybrid uterine septal resection at Hyogo Medical University Hospital between January 2017 and September 2021. Hysteroscopic uterine septum resection was performed in 16 patients, whereas 5 patients with vaginal septal complications underwent an additional vaginal septectomy under supervision by thin laparoscopy and fluoroscopy. The main outcome measures were pregnancy success rate and procedure safety.

Results: The results showed that the median operative time was 77 (46-114) min, and no cases of intraoperative or postoperative adverse events were identified. The postoperative pregnancy rate was 100.0% (7/7) and the live birth rate was 71% (5/7) in women with recurrent pregnancy loss. Among women with infertility, the postoperative pregnancy rate was 55.5% (5/9), and the live birth rate was 20% (1/5).

Conclusion: These findings indicate that our hybrid septal resection technique reduces patient burden and ensures safe and reliable surgery, with good results in terms of postoperative complications, pregnancy, and miscarriage rates.

References

Grimbizis G, Camus M, Tarlatzis B, Bontis J, Devroey P . Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001; 7(2):161-74. DOI: 10.1093/humupd/7.2.161. View

HULKA J, Peterson H, Phillips J, Surrey M . Operative hysteroscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey. J Am Assoc Gynecol Laparosc. 1995; 2(2):131-2. DOI: 10.1016/s1074-3804(05)80004-0. View

Sebbag L, Even M, Fay S, Naoura I, Revaux A, Carbonnel M . Early Second-Look Hysteroscopy: Prevention and Treatment of Intrauterine Post-surgical Adhesions. Front Surg. 2019; 6:50. PMC: 6706867. DOI: 10.3389/fsurg.2019.00050. View

. Uterine septum: a guideline. Fertil Steril. 2016; 106(3):530-40. DOI: 10.1016/j.fertnstert.2016.05.014. View

Ludwin A, Ludwin I, Coelho Neto M, Nastri C, Bhagavath B, Lindheim S . Septate uterus according to ESHRE/ESGE, ASRM and CUME definitions: association with infertility and miscarriage, cost and warnings for women and healthcare systems. Ultrasound Obstet Gynecol. 2019; 54(6):800-814. DOI: 10.1002/uog.20291. View

Kormanyos Z, Molnar B, Pal A . Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome. Hum Reprod. 2006; 21(4):1047-51. DOI: 10.1093/humrep/dei438. View

Saravelos S, Cocksedge K, Li T . Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008; 14(5):415-29. DOI: 10.1093/humupd/dmn018. View

Fedele L, Bianchi S, Marchini M, Mezzopane R, Di Nola G, Tozzi L . Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod. 1996; 11(4):727-9. DOI: 10.1093/oxfordjournals.humrep.a019242. View

Goyal L, Dhaliwal B, Singh P, Ganjoo S, Goyal V . Management of Mullerian Development Anomalies: 9 Years' Experience of a Tertiary Care Center. Gynecol Minim Invasive Ther. 2020; 9(2):81-87. PMC: 7354757. DOI: 10.4103/GMIT.GMIT_13_19. View

10.

Ghirardi V, Bizzarri N, Remorgida V, Venturini P, Ferrero S . Intraoperative Transrectal Ultrasonography for Hysteroscopic Metroplasty: Feasibility and Safety. J Minim Invasive Gynecol. 2015; 22(5):884-8. DOI: 10.1016/j.jmig.2015.03.005. View

11.

Sugiura-Ogasawara M, Lin B, Aoki K, Maruyama T, Nakatsuka M, Ozawa N . Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies?. J Obstet Gynaecol. 2014; 35(2):155-8. DOI: 10.3109/01443615.2014.936839. View

12.

Fedele L, Dorta M, Brioschi D, Giudici M, CANDIANI G . Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography. AJR Am J Roentgenol. 1989; 152(4):781-4. DOI: 10.2214/ajr.152.4.781. View

13.

Kougioumtsidou A, Mikos T, Grimbizis G, Karavida A, Theodoridis T, Sotiriadis A . Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study. Arch Gynecol Obstet. 2019; 299(3):779-789. DOI: 10.1007/s00404-019-05050-x. View

14.

Liu D, Zhang X, Zhang Z, Pan J, Ha C . Difference in post-surgical reproductive prognosis between transcervical resection and transcervical incision of the septum. Clin Exp Obstet Gynecol. 2014; 41(1):20-3. View

15.

Nouri K, Ott J, Huber J, Fischer E, Stogbauer L, Tempfer C . Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus--a retrospective cohort study and systematic review of the literature. Reprod Biol Endocrinol. 2010; 8:52. PMC: 2885403. DOI: 10.1186/1477-7827-8-52. View

16.

Chan Y, Jayaprakasan K, Zamora J, Thornton J, Raine-Fenning N, Coomarasamy A . The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011; 17(6):761-71. PMC: 3191936. DOI: 10.1093/humupd/dmr028. View

17.

. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2020; 113(3):533-535. DOI: 10.1016/j.fertnstert.2019.11.025. View

18.

Moayeri S, Lee H, Lathi R, Westphal L, Milki A, Garber A . Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis. Fertil Steril. 2008; 92(2):471-80. DOI: 10.1016/j.fertnstert.2008.05.074. View

19.

Rikken J, Kowalik C, Emanuel M, Bongers M, Spinder T, Jansen F . Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Hum Reprod. 2021; 36(5):1260-1267. PMC: 8058590. DOI: 10.1093/humrep/deab037. View

20.

Pfeifer S, Attaran M, Goldstein J, Lindheim S, Petrozza J, Rackow B . ASRM müllerian anomalies classification 2021. Fertil Steril. 2021; 116(5):1238-1252. DOI: 10.1016/j.fertnstert.2021.09.025. View