Hysteroscopic metroplasty in an acquired T-shaped uterus secondary to a multiple myomectomy: video report.
Ana Vegas Carrillo De Albornoz (ES), Irene López Carrasco (ES), Enrique Moratalla Bartolomé (ES), Carmen Martín Blanco (ES), María Miró Matos (ES), Nerea Montero Pastor (ES), Alejandra Salvaro (ES), María Luisa Cano Vieco (ES)
[Vegas Carrillo de Albornoz] HM Hospitales, [López Carrasco] HM Hospitales- Gine4 S.L., [Moratalla Bartolomé] HM Hospitales- Gine4 S.L., [Martín Blanco] HM Hospitales, [Miró Matos] HM Hospitales, [Montero Pastor] HM Hospitales- Gine4 S.L., [Salvaro] HM Hospitales- Gine4 S.L., [Cano Vieco] HM Hospitales- Gine4 SL
Context: Hysteroscopic metroplasty is a minimally invasive technique that allows us to correct anatomical uterine defects. About 15% of females with history of recurrent miscarriage and implantation failure present an abnormal uterine cavity. Many studies report that hysteroscopic metroplasty is a very effective technique in the correction of uterine cavity abnormalities specially in septated uterus and T-shaped uterus. Objective: We present a video of an hysteroscopic metroplasty in an acquired dysmorphic uterus. Methods: video report Patient: A 45 year-old woman presented to our histeroscopic unit with history of implantation failure after a cycle of IVF with oocyte donation after a multiple myomectomy. Intervention: The patient underwent hysteroscopy in early follicular phase, under general anaesthesia. Saline solution was used to distend the cavity. For the surgical procedure we used a 5Fr bipolar Versapoint electrode. A dysmorphic T-shaped cavity, probably secondary to the multiple myomectomy, with a type 0 myoma was found. The myoma was revomed. After this, the metroplasty was performed following a technique similar to the HOME-DU technique described by Di Spiezio et al. The incisions were done in lateral, anterior and posterior uterine walls in the fibrotic areas. These incisions permit the distention of the cavity and the result of the surgery was a normal uterine cavity. Main outcome measure: reproductive outcome after surgery. Results: Two months after the metroplasty, our patient received a new cycle of IVF with egg donator and got successfully pregnant. Nowadays she is 34 weeks pregnant with no complications. Conclusions: This minimally invasive technique seems to be safe and effective for the correction of the uterine morphology in dysmorphic uterus and has demonstrated that improves the rate of successful pregnancies.