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WJOLS

Hysteroscopy in Uterine Anomalies: An Edge
a cost-effective procedure. Given its minimally invasive include not only patients with recurrent pregnancy loss
approach, there is no scar formation or postoperative and premature labor but also patients with infertility,
adhesion, which allows the maintenance of integrity especially if IVF is being contemplated.
of uterine wall. The recovery time before conception is Consequently, for the correct differentiation between
shortened. Also, the probability of profuse bleeding and bicornuate and septate uteri, further investigation is
trauma is decreased when compared to abdominal ap- required, most commonly a diagnostic laparoscopy. So,
proach. All these advantages make hysteroscopy a better we also suggest that a hysterolaparo approach in such
option. There are different methods of performing opera- cases is very informative. In our cases also we have used
tive hysteroscopy. It may be performed using monopolar, this approach for better and correct diagnosis.
6
bipolar electrocautery, argon laser, or scissors, none of the Grimbizis et al considered the combination of hys-
particular modality being superior to other. 16,17 teroscopy and laparoscopy to be the gold standard in
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Gomel et al considered the combination of hyst- evaluating congenital uterine anomalies. Hysteroscopy
eroscopy and laparoscopy to be the gold standard in with laparoscopy offers the added advantage of concur-
evaluating congenital uterine anomalies in woman rent treatment, as in the case of a uterine septum resec-
with infertility. Hysteroscopy with laparoscopy offers tion. Hysteroscopic treatment seems to restore an almost
the added advantage of concurrent treatment, as in the normal prognosis for the outcome of their pregnancies
case of a uterine septum resection and often in complex with term delivery rates of approximately 75% and live
anomalies also. birth rates of approximately 85%. It seems, therefore,
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Maneschi et al performed diagnostic hysteroscopy that hysteroscopic septum resection can be applied as a
in women with abnormal uterine bleeding and detected a therapeutic procedure in cases of symptomatic patients
10% prevalence of uterine anomalies, which were associ- but also as a prophylactic procedure in asymptomatic
ated with a significantly higher incidence of spontaneous patients in order to improve their chances for a success-
abortion and lower cumulative live birth rates. ful delivery.
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Hamilton et al also suggested hysteroscopy to be Woelfer et al, however, concluded that the diagnosis
the gold standard for the diagnosis of uterine anomalies. is mainly based on the subjective impression of the
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Letterie suggested that hysteroscopy allows direct clinician performing them, and this is thought to be a
visualization of the intrauterine cavity and ostia. It is limitation in the objective estimation of the anomaly.
therefore very accurate in identifying congenital uter- Complications are similar to HSG, although rarely
ine anomalies and is often used to establish a definitive air emboli or uterine perforation may also occur. This
diagnosis after an abnormal HSG finding. statement is confirmed by the study of Kupesic et al. 24
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Soares et al studied 65 infertile women and con- Philbois et al in his study has said that combined
cluded that hysteroscopy is very accurate in identifying application of these endoscopic techniques is thought to
congenital uterine anomalies and is often used to estab- be the gold standard in the investigation of women with
lish a definitive diagnosis after an abnormal HSG finding. congenital malformations and especially the uterine ones.
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They also found hysteroscopy to be the gold standard Zlopasa et al conducted operative hysteroscopy on
for diagnosis. 105 infertile women with uterine anomalies. Compared
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Homer et al did a review of septate uterus manage- with their previous pregnancies, the abortion rates were
ment. They also highlighted that reliable diagnosis of the lower and delivery rates were higher in women who con-
septate uterus depends on accurate assessment of the ceived following hysteroscopic metroplasty. Resectoscope
uterine fundal contour. At present, the combined use of metroplasty significantly improved pregnancy outcome
laparoscopy and hysteroscopy is the gold standard for in women with uterine anomalies.
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diagnosis, although recent reports of two-dimensional Bettocchi et al recently proposed a new method
(2D), transvaginal, contrast ultrasound, and of the three- for differentiating between a septate and bicornuate
dimensional (3D) ultrasound appear promising. The prev- uterus with the use of office hysteroscopy alone, in a
alence of the septate uterus is increased in women with procedure that may also be performed without the use
repeated pregnancy loss. A meta-analysis of published of anesthesia or analgesia. Three criteria were used
retrospective data comparing pregnancy outcome before while assessing 260 patients with a double uterine cav-
and after hysteroscopic septoplasty indicated a marked ity: The presence of vascularized tissue, sensitivity of

improvement after surgery. They also concluded that the tissue based on its innervations, and its appearance
the hysteroscopic approach to treatment, with its sim- at incision (if suspected to be a septum). In this series,
plicity, minimal postoperative sequelae, and improved 93.1% of the patients went on to successfully undergo an
reproductive outcome, has enabled a more liberalized office hysteroscopic metroplasty during this procedure.

approach to treatment, i.e., now being extended to In 15 of 18 (83%) patients who underwent laparoscopy,
World Journal of Laparoscopic Surgery, May-August 2016;9(2):86-91 89