Endoscopic management of the intrauterine septum.

During 20 months of study 29 patients in whom congenital uterine anomalies were previously diagnosed by hysterosalpingography, had a combined hysteroscopy/laparoscopy procedure. In 17 cases, an intrauterine septum was cut under vision using CO2 hysteroscopy and/or optical scissors. No electrocautery or vasoconstrictor agents were needed to minimize the possibility of bleeding as the septum is of fibrous nature. No estrogen therapy was given and no IUDs were inserted post operatively. A second look hysteroscopy done 2 months later showed no intrauterine adhesions. Laparoscopic monitoring during the hysteroscopic procedure allowed avoidance of uterine perforation, assessment of the condition of the tubes and the ovaries as well as differentiation between bicornuate and septate uterus.