Intrauterine septaare are the most common congenital abnormality of the uterus. A septum could be complete (reaching the internal cervical os) or incomplete. They represent failure of resorption of the membrane between the mullerian ducts which make the uterine cavity. Usually the direction of resorption is from the cervix upwards toward the fundus. That is why most septae are incomplete rather than complete. It is different from a bicornuate uterus as the later one results from partial fusion failure of the mullerian ducts and the fundus is dipped inward for variable distances. This is usually shown as an angle of 90o or less on 3D rendered ultrasound scan examinations. Furthermore patients with septate uterine anomalies do not have any related renal anatomical problems. In fact many of them could have no related medical problems except for a miscarriage risk rate of 25.5% and fetal malpresentation during late pregnancy. See anatomic anomalies in Recurrent Miscarriages
Uterine septae could be incised using monopolar power set at 140 watt cutting mode and 80 watts coagulation mode. The needle electrode should be placed transversely at the midpoint of the septum between the anterior and posterior uterine walls. The septum is divided transversely by just touching the tissue with little pressure till both tubal ostia are visible at the same time in the same hysteroscopic field. Usually complete incision of the septum is identified as soon the avascular septum gives way to the vascular myometrium which would start bleeding when incised.Using intraoperative ultrasound monitoring the fundal myometrium should not be less than 10 to 13 mm thick by the end of the procedure. For incomplete septa we prefer using an operative hysteroscope with scissors without any electrical current. The septum is incised at the mid point transversely as described before. This would take a little longer time but would eliminate the risk of further scarring caused by the monopolar current.
Intrauterine septum being incised using only scissors without any electrical monopolar energy. The procedure was stopped when the ostia of the 2 tubes were seen in the same plane. A clue to the right level was to stop dissection when the pink healthy tissue is reached underneath the bloodless white septal tissue.
