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Vaginal hysterectomy may at times prove difficult and require laparoscopic assistance to ensure safety of operations. This article reports a case in which single port laparoscopic assistance enabled vaginal hysterectomy in a patient with severe uterine ventrofixation. The use of an innovative device and tips to be applied are described., (© 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.)

Study Objective: To evaluate 10 years' experience with hysteroscopic treatment of septate uterus in Italy., Design: Multicenter retrospective study conducted from January 1988 to March 1997 (Canadian Task Force classification II-2)., Setting: Twelve Italian centers for minimally invasive therapy., Patients: Women (total 973) with hysteroscopically diagnosed septate uterus., Interventions: Hysteroscopic metroplasty performed with scissors, resectoscope, or neodymium:yttrium-aluminum-garnet laser., Measurements and Main Results: Data on indications for hysteroscopic metroplasty, details of patient management from pretreatment to follow-up, and pregnancy course and delivery were collected by questionnaire. Main indications were two or more abortions and primary infertility. Most procedures were performed with the resectoscope, followed by scissors and laser. Few minor complications occurred. Pregnancy rates were good., Conclusion: Hysteroscopy is safe and effective treatment of septate uterus in terms of both pregnancy rate and outcome.

Patients with septate uterus usually undergo reproductive failures with recurrent abortions and premature deliveries. Up till now surgical therapy for such a defect has relied on different abdominal metroplasty procedures reflecting the need to establish normal anatomy and physiology of the uterus. Nowadays, wide experience accumulated in hysteroscopic management of intrauterine adhesions, has allowed the incision of the uterine septa with the hysteroscopic technique. In this report the Authors describe the surgical technique of the hysteroscopic metroplasty in eleven cases. Initial results are encouraging: surgical outcome is good, with no intra- or postoperative morbidity; if the pregnancy outcome rate confirms these results, then the traditional abdominal surgical approach should become an out-moded therapy, so making hysteroscopic metroplasty the treatment of choice for the uterine septa.

52 patients with septate uterus underwent hysteroscopic metroplasty in the Obstetric and Gynecologic Clinic "R" in Palermo. In this group of patients ultrasound examinations were also performed in order to define their role in diagnosis of type of malformations and in monitoring the endoscopic surgical procedure. Preliminary results seem to indicate that real-time ultrasound is a reliable technique for both purposes.