Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study.
OBJECTIVE
To compare 2 procedures for metroplasty: resectoscopy with monopolar knife versus small-diameter hysteroscopy fitted with a Versapoint device.


METHODS
Prospective randomized study (Canadian Task Force classification I).


METHODS
Endoscopic gynecology units at tertiary care university hospitals.


METHODS
One hundred-sixty patients with septate uterus and a history of recurrent abortion or primary infertility undergoing hysteroscopic metroplasty from 2001 to 2005.


METHODS
Hysteroscopic resection of the uterine septum performed with either a 26F resectoscope with unipolar knife (80 women, group A) or a 5-mm diameter hysteroscope with Versapoint device (80 women, group B). All patients were managed expectantly, with follow-up lasting 1 year.


RESULTS
Operative parameters (operative time, fluid absorption, complications, need for second intervention) and reproductive outcome parameters (pregnancy, abortion, term and preterm delivery, modality of delivery, cervical cerclage) were measured. Operative time and fluid absorption were significantly greater in group A than in group B (23.4 +/- 5.7 vs 16.9 +/- 4.7 minutes and 486.4 +/- 170.0 vs 222.1 +/- 104.9 mL, respectively). The cumulative complication rate was significantly lower in group B than in group A. No difference in any of the reproductive parameters was observed between the 2 groups: pregnancy and delivery rates were 70% and 81.6% in group A vs 76.9% and 84% in group B. Nine women (18.4%) from group B and 8 women (16%) from group B experienced spontaneous abortions. Most patients (54/82) delivered by cesarean section without differences according to the hysteroscopic technique used for metroplasty (65% in group A vs 67.7% in group B) or to the gestational age (65.1% of term and 68.7% of preterm deliveries).


CONCLUSIONS
Small-diameter hysteroscopy with bipolar electrode for the incision of uterine septum is as effective as resectoscopy with unipolar electrode regarding reproductive outcome and is associated with shorter operating time and lower complication rate.
Colacurci
Nicola
N
Department of Gynecology, Obstetrics and Reproductive Sciences, Second University of Naples, Naples, Italy.
De Franciscis
Pasquale
P
Mollo
Antonio
A
Litta
Pietro
P
Perino
Antonio
A
Cobellis
Luigi
L
De Placido
Giuseppe
G
D000328:Adult; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D004598:Electrosurgery / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D007247:Infertility, Female / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery*