Pneumovaginal endoscopic surgery to vaginal septum resection: a case report and literature review

Background: Longitudinal vaginal septa can cause symptoms such as dyspareunia and dysmenorrhea, and surgical treatments can sometimes be indicated. Septal excisions can be performed via direct speculoscopy, using laparoscopic instruments through a speculum, or using hysteroscopic instruments. Here, we present a novel technique to perform vaginal septal excisions using pneumovaginal endoscopic surgery. Since current knowledge regarding pneumovaginal endoscopic surgery is very limited and based on a small number of scientific reports, any additional evidence is useful to prove the feasibility and safety of this surgical approach. In addition, vaginal septal excision using pneumovaginal endoscopic surgery has been reported only once. Our case, in association with a literature review on all cases of vaginal conditions treated with this surgical approach, could help to increase scientific knowledge on this topic. Case Description: A 24 -year -old nulliparous woman presented with chronic dyspareunia due to a longitudinal complete vaginal septum associated with a uterocervical malformation type U3C2V1, according to the ESHRE/ESGE classification. The patient was placed in a dorsal lithotomy position under general anesthesia. Using a single -port device, a pneumovagina was created at a pressure of 6 mmHg. The vaginal septum was resected using an endoscopic sealer/divider device. The resection line on the posterior vaginal wall was endoscopically sutured using a 2/0 absorbable thread to approach the margins and to reduce the risk of synechiae formation. The operating time was 20 minutes. No perioperative complications were observed, and the patient was discharged the same day. During the 6 -month follow-up, the patient reported a rapid and complete resolution of dyspareunia without complications. Conclusions: Pneumovaginal endoscopic surgery provides a valuable alternative to conventional vaginal surgery for septum resections. This technique offers an improved view of the anatomic structures with greater exposure to the section plans and a more comfortable and ergonomic operating position, allowing for easy, safe, and precise resections.