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Laparoscopic-assisted transvaginal metroplasty for the treatment of bicornuate uterus: a case study
1Department of Obstetrics and Gynecology, Bayonne Hospital, New Jersey, 07002, USA.
Objective:
To introduce a combined laparovaginal metroplasty approach to the treatment of bicornuate uterus.
Design:
Case report.
Setting:
Private community hospital.
Patient:
A nulliparous patient with three recurrent spontaneous midtrimester abortions and a double uterus on hysterosalpingogram was evaluated laparoscopically.
Interventions:
A laparoscopic-assisted transvaginal wedge metroplasty for the surgical correction of a symptomatic bicornuate uterus was performed. Intraoperative hysteroscopy also was used.
Main Outcome Measures:
Term pregnancy, uterine integrity.
Results:
Hysteroscopic transillumination of the uterine horns delineated the uterine cavities while a laparoscopic wedge incision was initiated with a unipolar needle. The uterus was delivered through a posterior colpotomy, the wedge excision and uterine unification were completed transvaginally, the uterus was replaced into the pelvis, and the colpotomy was closed. The patient subsequently became pregnant, carried to term without complications, and delivered a healthy infant by cesarean section. The metroplasty scar was noted to be intact.
Conclusions:
Laparoscopic-assisted transvaginal metroplasty is a logical and useful minimally invasive alternative to laparotomy for the treatment of symptomatic bicornuate uterus and has potential utility for the treatment of complicated septate uterus and the correction of uterine perforation not amenable to laparoscopic suturing occurring during hysteroscopic septal resection.
