Removal of Uterine Septum
The uterus develops during intrauterine life as a result of fusion of the right and left müllerian ducts. When the fusion process fails to happen or occurs incompletely, a uterine septum results. The septum divides the usually capacious corporeal cavity into two smaller spaces. A complete septum extends to the level of the cervicocorporeal junction. An incomplete septum extends variable distances downward from the fundus toward the cervix. Total nonfusion results in a didelphic uterus, that is, completely separate bodies and cervices.
The diagnosis of a septate uterus is suspected unexplained preterm labor occurs. The condition does not lead to infertility. The diagnosis can be objectively made by a variety of techniques, including hysteroscopy. The hysteroscopic examination is conclusive. The cavity is divided by a vertical pillar of tissue extending from anterior to posterior walls (Fig. 108–1). The finding is analogous to viewing the end of a double-barreled shotgun head-on.
A diagnostic laparoscopic examination must always precede hysteroscopic takedown of the septum. The intra-abdominal aspect of the uterus is viewed to exclude the diagnosis of a bicornuate uterus. Finding the latter contraindicates hysteroscopic septum resection. The surgical procedure required to correct a bicornuate uterus is described in Unit II (Chapter 16). Similarly, laparoscopy is simultaneously performed during the septal surgery.
Hysterosalpingography will memorialize the septum’s structural presence and will document tubal patency (Fig. 108–2). Postoperative imaging will similarly document the adequacy of the surgery.
When the investigation has been completed, the septum is cut. The preferred tool to accomplish this is hysteroscopic scissors (Fig. 108–3
