Hysteroscopic metroplasty for a complete uterine septum: step-by-step technique and surgical pearls

Septate uterus is the most common congenital uterine anomaly. It is associated with increased risks of adverse obstetric outcomes. Hysteroscopic metroplasty is the standard minimally invasive treatment in selected patients, although its effect on reproductive outcomes remains controversial. We present a case of hysteroscopic metroplasty in a 31-year-old woman with a complete uterine septum extending to the internal cervical os (class U2b⁵) and a history of preterm delivery at 26 weeks gestation. The procedure was performed using an operative hysteroscope with a bipolar Versapoint spring electrode. The septum was resected progressively under direct visualization until both ostia were identified at the same level and healthy pink myometrial tissue was seen. This video case report demonstrates a systematic approach to hysteroscopic metroplasty, providing practical guidance for surgeons performing this procedure. Careful patient selection and detailed counselling are essential to ensure that appropriate candidates understand the current evidence.