Quick Case: MIS for Uterine Septum in a Rural Area Using URS

By: Dr. J. Gnanaraj and Dr. Linda Sailo

INTRODUCTION

The two Mullerian ducts join together to form the Uterus during embryogenesis. During the early stages there is a partition that dissolves later and sometimes the partition persist. The septum starts to disappear from below and go cranially [1]. The cause of this incomplete absorption is not known.

The incidence of the septum is about 3% in the women evaluated for infertility. The Septum is primarily scar tissue and lacks good blood supply and the endometrium over it does not respond to hormones. This probably contributes to infertility. Currently hysteroscopic resection is considered as gold standard for treatment [2].

CASE REPORT

Mrs. L presented to Bethesda Hospital in Aizawl for evaluation of infertility. She was posted for diagnostic scopy because of inability to dilate her uterine cervix. The Uterine sound went in different directions each time.

Scopy with Ureterorenoscope showed that there was two uterine cavities divided by a septum.

The division of the Septum was carried out using the Bugbee electrode passed through the Ureterorenoscope. After the initial division, it was easy to use Haegars dilators and then use the resectoscope to complete the division of the septum.

DISCUSSION

The take home message is that minimally invasive surgery is possible in rural areas when the available technology is appropriately used.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.