{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T17:18:02Z","timestamp":1778779082793,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Septate uterus is the most prevalent uterine malformation and is commonly associated with impaired reproductive outcomes. Hysteroscopic metroplasty is the gold standard treatment, but surgical management of complex septate uteri with associated cervical and vaginal anomalies remains challenging. This study aimed to evaluate surgical and reproductive outcomes following a standardized minimally invasive hysteroscopic approach using a 15 Fr bipolar mini-resectoscope across different subtypes. Methods: This retrospective single-center, single-surgeon study included women who underwent hysteroscopic correction of partial and complete septate uterus, with or without cervical and\/or vaginal anomalies, between January 2021 and January 2025 at the Digital Hysteroscopic Clinic CLASS Hysteroscopy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy. Preoperative assessment included three-dimensional transvaginal ultrasound and diagnostic hysteroscopy. All procedures were performed using a standardized hysteroscopic technique with a 15 Fr bipolar mini-resectoscope. Surgical outcomes included operative time and the need for second-step surgery. Reproductive outcomes included clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Results: A total of 154 patients were included, comprising 70 partial and 84 complete septate uteri; 52.4% of complete septa were associated with cervical and\/or vaginal anomalies. Median operative time was 18.0 min for partial septa and 31.0 min for complete septa (p &lt; 0.01), and a second surgical step was required in only 5\/84 complete septa (5.9%) and in none of the partial septa. Reproductive outcomes were analyzed in a subgroup of 70 patients who attempted conception. After metroplasty, CPR increased from 35.7% to 84.3% (p &lt; 0.01), LBR per pregnancy increased from 16.0% to 78.0% (p &lt; 0.01), and MR per pregnancy decreased from 84.0% to 10.2% (p &lt; 0.01). Postoperative reproductive outcomes appeared comparable between partial and complete septa and according to the presence of associated anomalies. Conclusions: A standardized hysteroscopic technique using a 15 Fr bipolar mini-resectoscope is feasible and effective for treating septate uterus, including complex cases associated with cervical and\/or vaginal anomalies. Favorable reproductive outcomes can be achieved regardless of anomaly complexity when accurate preoperative diagnosis and a structured surgical approach are applied.<\/jats:p>","DOI":"10.3390\/jcm15103786","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T16:27:56Z","timestamp":1778776076000},"page":"3786","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical and Reproductive Outcomes of a Standardized Hysteroscopic Approach to Treat Septate Uterus and Associated Complex Anomalies"],"prefix":"10.3390","volume":"15","author":[{"given":"Ursula","family":"Catena","sequence":"first","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0836-5260","authenticated-orcid":false,"given":"Emma","family":"Bonetti Palermo","sequence":"additional","affiliation":[{"name":"S.C. Ostetricia e Ginecologia, ASST Spedali Civili Brescia, Dipartimento Area Della Donna e Materno Infantile, 25136 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Pozzati","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Bernardini","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia Micol","family":"Bruni","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Department of Women\u2019s and Children\u2019s Health, University of Padova, 35141 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Campolo","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, Policlinico Abano Terme, 35031 Abano Terme, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2572-0886","authenticated-orcid":false,"given":"Eleonora","family":"La Fera","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5188-2508","authenticated-orcid":false,"given":"Michela","family":"Zorzi","sequence":"additional","affiliation":[{"name":"Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, 10060 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Naldini","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Moro","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"G-AURIG\u2014Gemelli Advanced Ultrasound Research and Innovation Group, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"UniCamillus International Medical University of Rome, 00131 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia Carla","family":"Testa","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"G-AURIG\u2014Gemelli Advanced Ultrasound Research and Innovation Group, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"},{"name":"Gemelli Women\u2019s Health Center for Digital and Personalized Medicine, Dipartimento Scienze della Vita e Sanit\u00e0 Pubblica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1093\/humupd\/dmr028","article-title":"The prevalence of congenital uterine anomalies in unselected and high-risk populations: A systematic review","volume":"17","author":"Chan","year":"2011","journal-title":"Hum. Reprod. Update"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/humrep\/det098","article-title":"The ESHRE\/ESGE consensus on the classification of female genital tract congenital anomalies","volume":"28","author":"Grimbizis","year":"2013","journal-title":"Hum. 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