Hysteroscopic incision of the septate uterus

Fifteen women underwent hysteroscopic incision of symptomatic septate uteri between April, 1982, and July, 1983. All procedures were performed on an outpatient basis with general anesthesia, by means of dextran hysteroscopy with direct-vision scissors incision of the septa under external laparoscopic guidance. No significant intraoperative nor postoperative complications occurred. Preoperative indications included repetitive pregnancy loss (eight), repetitive pregnancy loss and infertility (four), infertility and total uterine septum (one), preinsemination by donor (one), and intractable dysmenorrhea (one). A total of 72 hysteroscopic septal incision/resection procedures unassociated with any significant morbidity have been reported in the literature. Compared to transabdominal metroplasty, hysteroscopy is an outpatient procedure that avoids abdominal and uterine incisions and requires no long-term postoperative delay in attempting pregnancy. In addition, subsequent pregnancy does not require cesarean section. With these advantages, hysteroscopic incision of the symptomatic septate uterus can replace transabdominal metroplasty and allow liberalization of operative indications.