Efficacy of Transrectal Three-Dimensional Ultrasound-Guided Hysteroscopic Metroplasty

Background: Transabdominal ultrasound is not the standard for scanning pelvic structures, and the transvaginal route can result in repeated removals and reinsertions of the hysteroscope, with subsequent uterine refilling. Objective: The goal of this research was to evaluate the efficacy of transrectal 3-D ultrasound for intraoperative guidance during hysteroscopic metroplasty. Design: This pilot, prospective, randomized comparative study (Canadian Task Force classification I) was conducted in the Shatby Maternity University Hospital in Alexandria, Egypt. Materials and Methods: The study involved 60 patients with infertility or recurrent pregnancy-loss problems, who were diagnosed by hysterosalpingogram (HSG) and 3-D vaginal ultrasound to have uterine septa. The patients were randomized into two groups. Group A (30 patients) had hysteroscopic metroplasty with transrectal 3-D ultrasound performed intermittently during the procedure. Group B (30 patients) had hysteroscopic metroplasty without ultrasound guidance. All patients had postoperative HSG 3 months later. Results: A statistically significant longer operative time was found in group A (p = 0.001). No statistically significant difference was found between both groups regarding volume of fluid deficit and intraoperative complications. No residual septa were found on HSG 3 months postoperatively in group A, while 4 cases (13.3%) of residual septa were seen in group B, with a significant statistical difference between both groups (p = 0.04). Conclusions: Transrectal, 3D, ultrasound-guided hysteroscopic metroplasty seems to be a reliable, safe noninvasive tool that enables complete precise removal of a uterine septum in one session with no residual tissue remaining and no myometrium injury, thus eliminating the risk of uterine rupture in subsequent pregnancies. Moreover, there is no need for intraoperative laparoscopic monitoring or postoperative HSG.