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Uterine septum dissection using mini-hysteroscopy with a bipotrode 5 Fr bipolar electrode versus monopolar resectoscopy with a unipolar knife: a randomized-controlled study

Objective The aim of this study was to compare two procedures for uterine septum dissection: resectoscopy with a monopolar knife versus small-diameter hysteroscopy fitted with a bipotrode 5 Fr reusable bipolar electrode. Design Randomized-controlled study. Setting Tertiary University Fertility Care Unit. Main outcome measures Operative parameters (use of general anesthesia, cervical dilatation, operative time, volume of fluid used for uterine distention, complications, need for reseptoplasty) and reproductive outcome parameters (pregnancy, abortion, preterm delivery, live birth rate). Patients and methods Eighty-four patients with evident incomplete uterine septum and a history of recurrent miscarriage or unexplained infertility, undergoing hysteroscopic metroplasty from June 2005 to January 2010, were studied. Cases were allocated randomly to two groups. Group A included 42 women, who were subjected to the conventional hysteroscopic surgery using a resectoscope with a unipolar knife. Group B included 42 women who underwent resection with a 4-mm diameter hysteroscope with a bipotrode 5 Fr reusable bipolar electrode. The patients were followed up for 24 months. Results There was no statistically significant difference between both groups in age, BMI, and duration of infertility. General anesthesia and cervical dilatation were used in all cases of group A and in four cases of group B. Both operative time and volume of the fluid used for uterine distention were statistically significant greater in group A than in group B (25.4±3.2 and 15.6±2.2 min, P<0.001, and 710.4±120.4 and 1103±350.5 ml, P<0.001, respectively). There was no statistically significant difference between both groups in operative complications, need for reseptoplasty, and reproductive outcome parameters. Conclusion Small-diameter hysteroscopy with a bipotrode 5 Fr reusable bipolar electrode is as effective as resectoscopy with a unipolar electrode in terms of reproductive outcome. It is a safe, outpatient procedure and is associated with a significant reduction in the operative time, distending media, and postoperative stay. It can be used without anesthesia or cervical dilatation in the majority of cases.