Electrosurgical hysteroscopic metroplasty for septate uterus: a single-center retrospective analysis of safety, adhesion rates, and perioperative outcomes

Objective To evaluate the safety, adhesion rates, and perioperative outcomes of monopolar and bipolar electrosurgical hysteroscopic metroplasty in women with a septate uterus. Methods We conducted a single‐center retrospective analysis of 155 consecutive patients who underwent same-session laparoscopy and hysteroscopic septum resection between January 2021 and January 2025. Procedures were performed under surgeon discretion using either a monopolar loop with glycine distension or a bipolar loop with isotonic Ringer’s lactate. Postoperative prophylaxis against intrauterine adhesions comprised hyaluronic acid gel—with or without a copper intrauterine device—and, in selected extensive resections, a three‐month estrogen–progestin regimen. Endometriosis was diagnosed laparoscopically and, when lesions were excised, confirmed histologically. Results The most common indications for the surgery were endometriosis (40.6%), recurrent pregnancy loss (38.0%), and infertility (19.3%). Septal morphology was subseptate in 67.7%, septate in 20.0%, and complete septate in 12.2%, and bipolar energy was used in 65.1% of procedures. No uterine perforations, fluid-overload syndromes, or major hemorrhages occurred, and one case of postoperative endometritis (0.6%) was recorded. Second-look hysteroscopy, performed in 69 patients (44.5%), showed intrauterine adhesions in 3/69 (4.3%; grade I 2.9%, grade II 1.4%); residual septal tissue was observed in 50/69 (72.5%), predominantly in extensive septa. Histologically confirmed endometriosis, identified on concomitant laparoscopy, was present in 126/155 (81.3%) and did not differ across septal types ( p = 0.103). Conclusions Monopolar and bipolar electrosurgical hysteroscopic metroplasty showed a good safety profile with negligible major complications, low adhesion rates, and minimal infection. Bipolar systems further enhance safety by enabling isotonic fluid use.