Authors / metadata

  • Authors: Sanket Pisat (1), Pranay Desai (2)
  • Affiliation: 1: Department of Minimally Invasive Gynecologic Surgery, Akanksha Hospital, Maharashtra, Mumbai, India.
    2: Department of Minimally Invasive Gynecologic Surgery, Nirmala Maternity & Surgical Hospital, Maharashtra, Mumbai, India

DOI : 10.36205/trocar3.2023009

Hysteroscopic Septal Incision Using Scissors Following Laparoscopic Injection of Vasopressin Over the Uterine Fundus


Objective: To demonstrate the advantage of hysteroscopic septal incision using scissors following laparoscopic injection of vasopressin over the uterine fundus.
Design: A video case report (Video 1).
Setting: Hysteroscopic septal resection, an accepted treatment modality for septate uterus, is done using scissors, unipolar or bipolar resectoscope, and laser (1,2). Bleeding, fluid overload, uterine perforation, intra-uterine adhesions, and uterine rupture in forthcoming pregnancy due to undue use of electro-cautery and laser are some reported complications (3). Although, scissors have been found to be advantageous when compared to resectoscopy (4), bleeding encountered with the former can hinder vision.
Intervention: This video presents the technique of septal incision using scissors following laparoscopic injection of diluted vasopressin.

Key surgical steps

  1. Diagnostic hysteroscopy with laparoscopy to confirm presence of uterine septum.
  2. Laparoscopic injection of 1:10 diluted vasopressin, in the midline of the uterine fundus using Pisat’s VVIN (5).
  3. Hysteroscopic incision of the uterine septum using cold scissors.
  4. Procedure is deemed complete when both ostia appear to be in the same vertical plane, and are visualized in a single view when the telescope is at the internal os.
  5. Clear field of vision is maintained throughout the procedure as there is no bleeding from cut edges.



Laparoscopic injection of vasopressor solution over the uterine fundus makes hysteroscopic incision of uterine septum with scissors a straightforward and a relatively inexpensive procedure. Lack of bleeding provides a clear view and thus avoids the need of a resectoscope and its associated complications.


  • 1. Pfeifer Samantha, Butts Samantha, Dumesic Daniel, et al. Uterine septum: a guideline. Fertil Steril. 2016;106(3):530–40. Doi: 10.1016/J.FERTNSTERT.2016.05.014.
  • 2. Paradisi Roberto, Barzanti Rita, Fabbri Raffaella. The techniques and outcomes of hysteroscopic metroplasty. Curr Opin Obstet Gynecol. 2014;26(4):295–301. Doi: 10.1097/GCO.0000000000000077.
  • 3. Valle Rafael F., Ekpo Geraldine E. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. JMIG. 2013;20(1):22–42. Doi: 10.1016/J.JMIG.2012.09.010.
  • 4. Cararach M., Penella J., Ubeda A., Labastida R. Hysteroscopic incision of the septate uterus: scissors versus resectoscope. Hum Reprod. 1994;9(1):87–9. Doi: 10.1093/OXFORDJOURNALS.HUMREP.A138326.
  • 5. Pisat Sanket V. Pisat’s Visual Vasopressor Injection Needle: A New Device for Increasing Patient Safety in Laparoscopic Myomectomy. J Obstet Gynaecol India. 2017;67(6):451. Doi: 10.1007/S13224-017-1048-6.