Standardized hysteroscopic management of complete septate uterus with duplicated cervices and longitudinal vaginal septum: A single‐center experience

OBJECTIVE: To study perioperative and postoperative complications of a standardized ultrasound-guided hysteroscopic treatment for complete septate uterus with duplicated cervices and non-obstructive longitudinal vaginal septum, and to evaluate operative time, symptom changes, and reproductive outcomes. METHODS: Between January 2021 and May 2025, patients diagnosed with complete septate uterus, duplicated cervices, and non-obstructive longitudinal vaginal septum at a tertiary referral center underwent hysteroscopic resection of the uterine and vaginal septum using a 15 Fr bipolar mini-resectoscope under real-time ultrasound guidance, with preservation of the duplicated cervices. Primary outcomes were perioperative and postoperative complications. Secondary outcomes included operative time trends over consecutive cases, symptom changes before and after surgery, and reproductive outcomes (clinical pregnancy rate, live birth rate, miscarriage rate, and pregnancy-related complications). RESULTS: Twenty-eight patients were included. Surgical correction was successfully completed in all cases, with no perioperative or postoperative complications. Median operative time was 61.5 min (range 21-94 min) and decreased modestly over consecutive procedures. At follow up, all patients showed a regular triangular uterine cavity on three-dimensional transvaginal ultrasound. Median follow up was 24 months (range 3-54 months). Symptoms improved in nearly all patients; only one patient (3.5%) reported persistent dyspareunia. Among the 11 patients who attempted conception, the clinical pregnancy rate was 100% (11/11). The live birth rate per pregnancy was 63.6% (7/11), with two pregnancies ongoing at last follow up. CONCLUSION: This standardized ultrasound-guided hysteroscopic approach using a 15 Fr bipolar mini-resectoscope for the treatment of complete septate uterus with duplicated cervices and non-obstructive longitudinal vaginal septum appears safe and reproducible, with favorable anatomic, symptom, and reproductive outcomes.