Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey.
Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.
J Minim Invasive Gynecol. 2018 Jan;25(1):28-29. doi: 10.1016/j.jmig.2017.06.015. Epub 2017 Jun 22.
To demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature.
Resection of an asymmetric uterine septum by laparoscopy and ultrasound-guided hysteroscopy (Canadian Task Force classification III). The video was assumed exempt from official review by our institutional review board.
A septate uterus is defined as the uterus in which the uterine cavity is longitudinally divided by the septum [1]. The most common uterine anomaly, septate uterus has a spectrum of configurations ranging from complete septate to incomplete septate uterus. Asymmetric uterine septum was reported only as case reports in the literature and is described as Robert's uterus [2]. This unique malformation is described as a septate uterus with a noncommunicating hemicavity, composed of a blind uterine horn usually with unilateral hematometra, and a contralateral unicornuate uterine cavity. The external uterine shape is normal. The asymmetric septum with transverse uterine septum in the present case has not yet been reported in the literature.
A 29-year-old woman presented to our clinic with primary amenorrhea, cyclic pelvic pain, and the desire to have pregnancy. She previously had failed 2 laparoscopy and hysteroscopy procedures for fertility treatments. Hysterosalpingography previously had been failed. The patient previously underwent magnetic resonance imaging. The magnetic resonance imaging report states there was no connection between the uterus and cervix. On external genital organs assessment, there was no abnormal sign. Ultrasonography revealed 2 uterine cavities and hematometra. Both ovaries were in normal view.
In view of her examination findings, the patient was scheduled for laparoscopy and hysteroscopy. Laparoscopy revealed extensive adhesions on both the pelvis and upper abdomen. Initially, the uterus and ovaries were not visualized. Adhesiolysis was performed, and normal anatomy was restored. After this step, the operation was continued by laparoscopy and ultrasound-guided hysteroscopy. Under ultrasound and laparoscopy guidance, the transverse uterine septum at the level of uterine isthmus was incised and the left endometrial cavity was observed with hysteroscopy. The asymmetric uterine septum was then incised, and the right-sided endometrial cavity was then accessed. Finally, the uterine septum was completely incised and both sides of the endometrial cavities were merged. The patient had an uncomplicated postoperative course and was discharged 24 hours after surgery. She returned for follow-up examination in the second month after surgery. She had regular menstrual cycles, and her pain was cured.
Hysteroscopy and laparoscopy combined with ultrasound is a useful method for the diagnosis and treatment of asymmetric uterine septum. The skill and experience of the laparoscopic surgeon is another important factor to identify and manage unusual uterine malformations.
在一例既往文献中未描述的非对称性子宫中隔和横向子宫中隔患者中，演示腹腔镜和超声引导宫腔镜手术的分步技术。
腹腔镜和超声引导宫腔镜下切除非对称性子宫中隔（加拿大任务组分类 III）。该视频被认为符合我们机构审查委员会的官方审查豁免。
中隔子宫定义为子宫腔被中隔纵向分隔的子宫[1]。最常见的子宫异常是中隔子宫，其形态从完全中隔到不完全中隔子宫不等。非对称性子宫中隔仅在文献中作为病例报告报道，被描述为罗伯特子宫[2]。这种独特的畸形被描述为一个不与宫腔相通的半宫腔，由一个盲子宫角组成，通常伴有单侧宫腔积血，以及对侧单角子宫腔。子宫外部形状正常。本例中的非对称性中隔伴横向子宫中隔在文献中尚未报道。
一位 29 岁的女性因原发性闭经、周期性盆腔疼痛和妊娠愿望就诊于我院。她之前因生育治疗进行了 2 次腹腔镜和宫腔镜手术，但均未成功。子宫输卵管造影术之前也未成功。患者之前接受过磁共振成像检查。磁共振成像报告指出子宫和宫颈之间没有连接。外阴检查无异常体征。超声检查显示有 2 个子宫腔和宫腔积血。双侧卵巢均可见。
鉴于她的检查结果，患者被安排行腹腔镜和宫腔镜检查。腹腔镜检查显示骨盆和上腹部广泛粘连。最初，子宫和卵巢无法观察到。进行粘连松解，恢复正常解剖结构。在这一步之后，手术继续在腹腔镜和超声引导宫腔镜下进行。在超声和腹腔镜引导下，切开子宫峡部的横向子宫中隔，宫腔镜观察左侧子宫内膜腔。然后切开非对称性子宫中隔，进入右侧子宫内膜腔。最后，完全切开子宫中隔，使两侧的子宫内膜腔融合。患者术后恢复顺利，术后 24 小时出院。她在术后第二个月进行了随访检查。她的月经周期正常，疼痛也得到了缓解。
宫腔镜和腹腔镜联合超声是诊断和治疗非对称性子宫中隔的有效方法。腹腔镜外科医生的技能和经验是识别和处理异常子宫畸形的另一个重要因素。
