Beyond hysteroscopic metroplasty: time to distinguish fundal from ampliative procedures

Functional intrauterine surgery has recently been proposed as a conceptual framework shifting the focus from anatomical correction alone toward restoration of uterine function and reproductive competence. However, hysteroscopic treatment of congenital uterine anomalies continues to be described under the umbrella term metroplasty, despite substantial differences in uterine morphology, surgical targets, and reconstructive objectives. In this Opinion Paper, we propose distinguishing two categories of hysteroscopic reconstructive procedures: fundal metroplasty and ampliative metroplasty. Fundal metroplasty primarily addresses midline fundal anomalies, most commonly the septate uterus, through a subtractive approach aimed at restoring normal uterine architecture. Conversely, ampliative metroplasty addresses globally restricted or dysmorphic uterine cavities through an expansive approach aimed at enlarging and reshaping the cavity. The use of a single term for these distinct procedures may contribute to conceptual ambiguity in surgical terminology. Rather than proposing a new classification system, we suggest terminology based on the anatomical target and reconstructive objective of hysteroscopic surgery. Distinguishing fundal from ampliative metroplasty may facilitate more precise communication and research and provide a clearer framework for hysteroscopic reconstructive surgery within the broader concept of Functional Intrauterine Surgery.