title: Accuracy of Hysteroscopic Metroplasty With the Combination of Presurgical 3-Dimensional Ultrasonography and a Novel Graduated Intrauterine Palpator: A Randomized Controlled Trial.
abstract: STUDY
  
  
  
  To assess whether the use of a novel graduated intrauterine palpator can improve the accuracy of hysteroscopic metroplasty, introducing objective intraoperative criteria.
  
  
  
  A prospective randomized study (Canadian Task Force I, evidence obtained from a properly design, randomized, controlled trial).
  
  
  
  University Federico II hysteroscopic clinic.
  
  
  
  Ninety women with a uterine septum diagnosed during office hysteroscopy and 3-dimesional transvaginal ultrasound (3D-TVS) were randomized into 2 groups: group T (metroplasty with intrauterine palpator) (n = 45) and group C (metroplasty without intrauterine palpator) (n = 45).
  
  
  
  Outpatient hysteroscopic metroplasty under conscious sedation using a 5-mm hysteroscope and miniaturized 5F instruments including a bipolar electrode for the removal of three quarters of the septum, blunt scissors to refine the base of the septum, and an intrauterine palpator to measure the portion of the removed septum (only group T). 3D-TVS and second-look hysteroscopy were used to identify the number of optimal (residual septum <5 mm), suboptimal (residual septum 5-10 mm), and incomplete resections (residual septum >10 mm). In group T, metroplasty was stopped when the intrauterine palpator showed that the resected septum corresponded to presurgical ultrasonographic measurements in order to obtain a fundal notch of 1.0 cm. In group C, metroplasty was interrupted once the tubal ostia were clearly visible on the same line and/or hemorrhage from small myometrial vessels of the fundus was observed.
  
  
  
  No differences were observed in baseline characteristics between the 2 groups. The proportion of patients with complete septum resection was significantly higher in group T (71.5% vs 41%, χ(2): p = .006; relative risk: 1.684; 95% confidence interval, 1.116-2.506). Suboptimal resection was achieved in 13 cases (28.5%) in group T and 14 cases (20%) in group C, whereas incomplete resection was observed in only 12 patients in group C (27%).
  
  
  
  Presurgical evaluation with 3D-TVS together with the use of a graduate intrauterine palpator improves the accuracy of hysteroscopic metroplasty, allowing complete removal of a uterine septum in 1 surgical step.
authors.affiliation: Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy. Electronic address: cdispie@tin.it.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy.
authors.forename: Brunella
authors.initials: B
authors.lastname: Zizolfi
authors.affiliation: Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University Aldo Moro, Bari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bettocchi
authors.affiliation: University of "Tor Vergata", Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Exacoustos
authors.affiliation: Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Nocera
authors.affiliation: Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nazzaro
authors.affiliation: Department of Gynecology and Obstetrics, ABC Foundation School of Medicine, São Paulo, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: da Cunha Vieira
authors.affiliation: Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D009215:Myometrium / Q000000981:diagnostic imaging; D011446:Prospective Studies; D024162:Second-Look Surgery / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*; D014599:Uterus / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: 3-Dimensional ultrasonography; Hysteroscopy; Residual septum; Uterine septa