Complete Vaginal, Intracervical and Intrauterine Septum

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2 years ago

Case description

Resection of complete vaginal septum, keeping intracervical septum, resection of intrauterine septum (ESHRE/ ESGE class U2BC1V1). Clinical examination and 3D USG is required for the diagnosis of this problem. This is a prototype example of surgery offered in such cases. We have standardized surgical technique in this type of mullerian dysgenesis.. Laparoscopic examination shows broad uterine fundus. Vertical vaginal septum is cut in midline by ultrasound dissector. It is cut in centre upto cervix. Vaginoscopy , hysteroscopy reveals complete intrauterine and cervical septa. Bipolar 22fr resectoscope is used to cut septa above internal OS. On one side resectoscope is introduced , on another side 7 mm metal dilator is used to point and push just above internal OS towards other side of cavity where resectoscope is introduced, By gentle push movements of this dilator on opposite side septal movements are noticed Collins knife cuts full thickness of septa at this location. In video the dilator is seen on other cavity once the septa is completely cut. Dilator is withdrawn. Now Resectoscope is inserted through the other side of uterine cavity (where dilator was inserted) and uterine septum is completely cut in upper portion. In case of septate uterus, generally we notice asymmetric cavities. At the end lower portion of uterine septum is cut upto internal OS.. All patients treated had spontaneous conception in the follow up period. Cervical encerclage was performed in all. Patients were delivered by cesarean section (Unpublished data). Cervical encerclage suture encircles both cervix.

tags: vaginal septum resection

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