The step-by-step hysteroscopic treatment of patients with vaginal and complete uterine septum with double cervix (U2bC2V1)

Objective: To demonstrate a systematic approach for the hysteroscopic management of a patient with uterine septum with double cervix and a nonobstructive longitudinal vaginal septum (Class U2bC2V1 of the ESHRE/ESGE classification). Design: A step-by-step demonstration of the technique with narrated video footage of three different cases. Setting: University Hospital. Patient(s): We present three patients diagnosed with uterine septum with double cervix and a nonobstructive longitudinal vaginal septum (Class U2bC2V1 of the ESHRE/ESGE classification). Case 1 is a 31-year-old woman with class U2bC2V1 müllerian anomaly and primary infertility. Case 2 is a 29-year-old patient with class U2bC2V1 müllerian anomaly, infertility, and dyspareunia. Case 3 is a 32-year-old patient with class U2bC2V1 müllerian anomaly, infertility, and abnormal uterine bleeding. She also was diagnosed with a submucous leiomyoma. Intervention(s): Hysteroscopic management of this complex müllerian anomaly using miniaturized hysteroscopic instruments, including the mini-resectoscope, was performed. All three procedures were performed in the operating room with the patient under general anesthesia. No complications were encountered. Patients were discharged home the same day of the procedure after a short period of observation. The critical aspects of the procedure are highlighted. Main Outcome Measure(s): Description of the systematic approach with a detailed demonstration of the critical steps of the procedure. Result(s): Complete resolution of the vaginal septum with creation of a single uterine cavity was obtained in all three cases. Absence of intrauterine adhesion formation was confirmed. Conclusion(s): Due to the recent innovations in hysteroscopic equipment and improved surgical techniques, the hysteroscopic management of patients with complex müllerian anomalies using miniaturized instruments is a feasible and effective treatment option.