Intraoperative Assessment of Residual Septum Length During Hysteroscopic Metroplasty Using Electrode-Based In-Field Measurement and Fundal Thickness Monitoring

Background/Objectives: Determining when to stop septal incision is a practical issue in hysteroscopic metroplasty (HM). We describe a combined intraoperative approach targeting an approximately 5 mm residual septum. Methods: This single-center retrospective case series included 32 consecutive patients undergoing HM by one surgeon between May 2024 and April 2026. Electrode-based semi-quantitative assessment was combined with sonohysterographic fundal thickness monitoring. Postoperative morphology was assessed at 2 months. Stored final intraoperative ultrasound images were retrospectively evaluated when available. Results: All 32 patients completed postoperative imaging and second-look hysteroscopy. Median postoperative residual septum length was 7.0 mm (interquartile range, 5.7–8.6; range, 2.9–10.0); 30 patients (93.8%) had a residual length below 10 mm and two had a length of 10.0 mm. Final intraoperative images were available in 16 patients: median full fundal thickness was 13.9 mm (range, 11.2–15.8), and the calculated residual length was 3.6 mm (range, 0.6–5.5). No adhesions occurred at the uterine-body incision site; one cervical adhesion required subsequent excision. No uterine perforation or major intraoperative hemorrhage occurred. No postoperative infection or repeat surgery for a residual septum was recorded through second-look hysteroscopy (median, 62 days; range, 59–93 days). Conclusions: This series describes the application and feasibility of two complementary intraoperative assessments. Measurement accuracy, reproducibility, and comparative safety or effectiveness remain untested and require prospective evaluation.