1329 Surgical Management of Longitudinal Vaginal Septum and Complete Uterine Septum

Video Objective To illustrate the steps for surgical correction of a longitudinal vaginal septum and complete uterine septum using narrative video footage. Setting A longitudinal vaginal septum and complete uterine septum are anomalies of Mullerian duct development that occur during embryological development. The exact incidence of Mullerian anomalies is difficult to determine, since women with them are often not diagnosed if asymptomatic, but is approximately 2-3%. In women who present with infertility, the incidence of uterine anomalies is often higher, approximately 5-10%. Although some women with vaginal anomalies are asymptomatic, some may note difficulty inserting tampons or dyspareunia. Reproductive outcomes in women with a complete uterine septum include possible decreased chance of implantation, and increased risk of spontaneous abortion and preterm labor/delivery. Benefits of surgical correction of a uterine septum include possible improved reproductive success and decreased poor obstetric outcomes. Interventions In this video, we illustrate the key surgical steps of excision of a longitudinal vaginal septum and hysteroscopic metroplasty for a complete uterine septum resection. Key surgical steps include: 1. Exam under anesthesia Lidocaine with epinephrine injection into vaginal septum. 2. Excision of septum with mayo scissors and re-approximation of vaginal mucosal edges. 3. Dilation of one side of cervical canal and placement of pediatric foley catheter to instill methylene blue-dyed fluid. 4. Hysteroscopic incision of septum using bipolar resectoscope until blue dye is visualized. 5. Complete incision of uterine septum. 6. Placement of uterine balloon for endometrial healing. 7. Vaginal packing placed to promote vaginal healing. Conclusion Surgical management of a longitudinal vaginal septum and complete uterine septum is a minimally invasive procedure to correct these Mullerian anomalies that could impact a woman's quality of life and possible reproductive success in the future.