The use of hysteroscopic metroplasty with diode laser to increase endometrial volume in women with septate uterus: preliminary results

Background The aim of our study was to assess the feasibility, safety and efficacy of office hysteroscopic metroplasty using a dual-wavelength (980nm and 1470nm) diode laser system and to evaluate with 3D ultrasound endometrial volume before and after procedure in women with septate uterus (class U2A) Methods We enrolled 6 consecutive patients with septate uterus who were scheduled for office hysteroscopic metroplasty with diode laser between February 2019 and November 2019 in University of Foggia and Cagliari. Endometrial volume was evaluated before and 3 months after surgery using 3D transvaginal ultrasound. The surgical procedure was uncomplicated in all patients and was performed with 4mm hysteroscope (Bettocchi Office Hysteroscope, Karl Storz, Tuttlingen, Germany) with vaginoscopic approach in an office setting, with no anesthesia nor sedation. We used a new Dual wavelengths Laser System (Leonardo® Dual 45, Biolitec, Germany). This laser is characterized by combination of two wavelengths (980 nm and 1470 nm), giving contemporary capacity of cutting and vaporization. A second hysteroscopic look to evaluate residual septa or the presence of adhesions was performed after three months. Additionally, in order to assess the uterine morphology and measure the endometrial volume after the procedure, 3D TV-US was performed in luteal phase, one week after ovulation in a controlled spontaneous menstrual cycle (after at least two regular spontaneous menstrual cycle). Results The surgical procedure consisted in the complete vaporization and removal of the septum starting from the apex. Patients were all discharged a few hours after the procedure with no early complications. Median endometrial volume was significantly lower preoperatively 4.4 (range 2.5-5.5) versus 6.5 (range 4.4-7.6) cm3post surgery, p: 0.019 and the median increase before and after surgery was 1.9 cm3 (range 1.7-2.1) At the moment of the current study, a 12 months follow up has been performed in all the patients. None of the patients have has reported any adverse effect and one patient has had a spontaneous pregnancy with vaginal uncomplicated delivery. Conclusions Office hysteroscopic metroplasty with diode laser is a safe procedure and has preliminary showed to increase endometrial volume. The increase in endometrial volume by 3D-TV US could be used as a prognostic factor for the reproductive outcomes.