Laparoscopic Metroplasty for Bicorporeal Uterus: Surgical Techniques and Outcomes
Congenital uterine anomalies (CUA) are more prevalent than previously thought, with improved diagnostic imaging modalities revealing an estimated prevalence of 5.5% in the unselected population, 8.0% in infertile women, and 13.3% in women with a history of miscarriage. The most common anomalies are septate uterus (canalization defects) and bicornuate uterus (fusion defects). These anomalies are associated with adverse reproductive outcomes, including increased miscarriage rates, preterm delivery rates, and perinatal mortality rates. While hysteroscopic resection of a septate uterus has shown promise in reducing miscarriage risk, the treatment of bicorporeal uterus has been less explored due to the invasiveness of traditional procedures like the Strassmann unification surgery. However, laparoscopic metroplasty has emerged as a safer and feasible alternative with favorable reproductive outcomes.
This article presents the largest series of laparoscopic metroplasty for bicorporeal uterus, detailing surgical techniques, outcomes, and follow-up data. The study was conducted at Fuxing Hospital, Beijing, China, and included 32 women with a mean age of 29.9 years diagnosed with bicorporeal uterus. All patients had a poor reproductive history, including recurrent miscarriages or preterm births. Comprehensive screening for genetic, thrombophilic, immunological, metabolic, and endocrinologic factors was performed, and CUA was confirmed using 2D/3D ultrasound, hysteroscopy, and magnetic resonance imaging. Patients were counseled on expectant management or laparoscopic metroplasty, with those opting for surgery undergoing the procedure under the supervision of experienced surgeons.
The surgical procedure began with saline hysteroscopy to assess the uterine cavity and fundal indentation. A 10 mm trocar was inserted via an intraumbilical incision, and CO2 was insufflated into the abdominal cavity. Three additional 5 mm trocars were placed in the lower quadrants. After adhesiolysis, an intrauterine Foley catheter balloon was inserted into the right uterine cavity and inflated with saline. Vasopressin was injected into the right uterine horn, and an incision was made using monopolar diathermy and cold scissors. The process was repeated for the left uterine horn, and the uterine cavity was unified using interrupted polyglactin sutures, sparing the endometrial tissue. Interceed was applied to the sutured area, and prophylactic antibiotics and oxytocin were administered postoperatively. A second-look hysteroscopy was performed at 8 weeks to confirm unification and address intrauterine adhesions.
The mean duration of the operation was 143.2 minutes, with a median blood loss of 50 mL. At follow-up, 93.8% of patients had a satisfactorily unified cavity, and 6.3% had intrauterine adhesions, which were successfully treated. Among the 18 patients who attempted conception, 14 became pregnant, with a mean time to conception of 21 months. Of the 13 pregnancies with complete follow-up, there were no ectopic pregnancies or early miscarriages. One late miscarriage, three preterm deliveries, and nine term deliveries were reported. All newborns survived, and there were no cases of uterine rupture, intrauterine growth restriction, placental abruption, retained placenta, or placenta accreta. One case of placenta previa was managed successfully.
The study highlights the feasibility and safety of laparoscopic metroplasty for bicorporeal uterus, with favorable reproductive outcomes. The procedure was associated with minimal intraoperative complications, high rates of uterine cavity unification, and improved pregnancy outcomes. The conception rate of 14/18 and term delivery rate of 9/13 are comparable to outcomes in women with unexplained recurrent pregnancy loss receiving supportive care. Additionally, the study underscores the importance of addressing cervical weakness in women with uterine anomalies, with six patients receiving laparoscopic transcervical cerclage and one receiving transvaginal cerclage.
This series represents the largest reported cohort of laparoscopic metroplasty for bicorporeal uterus, providing valuable data on surgical and reproductive outcomes. The findings suggest that laparoscopic metroplasty is a viable alternative to traditional laparotomic approaches, with encouraging results that warrant further investigation through prospective trials. The study contributes to the growing body of evidence supporting minimally invasive surgical techniques for the management of congenital uterine anomalies, offering hope for improved reproductive outcomes in affected women.
doi.org/10.1097/CM9.0000000000001266
Was this helpful?
0 / 0