ArticleArchives of gynecology and obstetrics2025
Electrosurgical hysteroscopic metroplasty for septate uterus: a single-center retrospective analysis of safety, adhesion rates, and perioperative outcomes.
Article in Archives of gynecology and obstetrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the safety, adhesion rates, and perioperative outcomes of monopolar and bipolar electrosurgical hysteroscopic metroplasty in women with a septate uterus.
methodsWe conducted a single-center retrospective analysis of 155 consecutive patients who underwent same-session laparoscopy and hysteroscopic septum resection between January 2021 and January 2025. Procedures were performed under surgeon discretion using either a monopolar loop with glycine distension or a bipolar loop with isotonic Ringer's lactate. Postoperative prophylaxis against intrauterine adhesions comprised hyaluronic acid gel-with or without a copper intrauterine device-and, in selected extensive resections, a three-month estrogen-progestin regimen. Endometriosis was diagnosed laparoscopically and, when lesions were excised, confirmed histologically.
resultsThe most common indications for the surgery were endometriosis (40.6%), recurrent pregnancy loss (38.0%), and infertility (19.3%). Septal morphology was subseptate in 67.7%, septate in 20.0%, and complete septate in 12.2%, and bipolar energy was used in 65.1% of procedures. No uterine perforations, fluid-overload syndromes, or major hemorrhages occurred, and one case of postoperative endometritis (0.6%) was recorded. Second-look hysteroscopy, performed in 69 patients (44.5%), showed intrauterine adhesions in 3/69 (4.3%; grade I 2.9%, grade II 1.4%); residual septal tissue was observed in 50/69 (72.5%), predominantly in extensive septa. Histologically confirmed endometriosis, identified on concomitant laparoscopy, was present in 126/155 (81.3%) and did not differ across septal types (p = 0.103).
conclusionsMonopolar and bipolar electrosurgical hysteroscopic metroplasty showed a good safety profile with negligible major complications, low adhesion rates, and minimal infection. Bipolar systems further enhance safety by enabling isotonic fluid use.
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