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Dilatation and Curettage

Suction Curettage
for Abortion

Management of Major
Uterine Perforations
From Suction Curet or
Radium Tandem

Cesarean Section


Jones Operation
for Correction of
Double Uterus

Hysteroscopic Septal
Resection by Loop
Electrical Excision
Procedure (LEEP) for
Correction of a Double

Manchester Operation

Richardson Composite Operation

Total Vaginal Hysterectomy

Total Abdominal
Hysterectomy With
and Without Bilateral

Laparoscopy-Assisted Vaginal Hysterectomy

Jones Operation for Correction
Of Double Uterus

The term "double uterus" in this atlas refers to the various embryologic deformities resulting from failure of fusion of the Mullerian ducts. Most patients with a double uterus have no reproductive difficulties or fetal wastage and do not need surgical intervention. Approximately 20%, however, have habitual first-or second-trimester abortions.

Several procedures are available for correction of the double-uterus deformity (Strassman, Tompkins, and Jones operations). We have chosen to present the surgical details of the Jones operation because in our opinion it is the most physiologic approach for the correction of this deformity.

The purpose of the operation is to restore the uterus to its normal configuration by removing the fibrous septum.

Physiologic Changes. The fibrous septum within a double uterus makes a poor implantation site for the placenta. It lacks the proper endometrial lining necessary to support nidation and placental growth.

By removing this fibrous septum, the placenta grows on a normal, healthy endometrium.

Points of Caution. Many obstetricians prefer to deliver all of these patients by cesarean section at term prior to labor.

Care must be taken to ensure that parallel incisions into the fundus of the uterus are made to prevent cornual dissection of the myometrium. Cornual dissection may jeopardize the intramural portion of the Fallopian tube.

All of the fibrous septum must be removed.


A frontal section of the uterus with the uterine septum is shown. The dotted line indicates the wedge to be excised.

The patient is placed on the operating table in the dorsal position. We have found it helpful to insert a Foley catheter through the cervix into the endometrial cavity and instill 10 mL of an indigo carmine solution to stain the endometrial cavity prior to the uterine incision.

A second Foley catheter should be inserted into the bladder.

The abdomen can be opened through a midline or transverse incision. The bowel is packed away, and a self-retaining retractor is used to keep the abdominal wound open. The fundus is palpated with the thumb and index finger to locate the extent of the fibrous septum. A traction suture is placed in the midportion of the uterus. Additional traction sutures are placed lateral to the fibrous septum.

The myometrium is injected at several points with a saline-Pitressin solution (10 international units of Pitressin in 30 mL of saline solution). Injection of this solution, which produces contraction of the uterus, has been superior to applying a tourniquet to the lower uterine segment for hemostasis. Regardless of the hemostatic technique used (tourniquet or Pitressin injection), a bloodless field in the operating wound is essential for meticulous dissection and accurate placement of suture material. Brilliant green solution is used to mark the lateral extent of the fibrous septum as determined by palpation of the uterus.

A scalpel is used to open the fundus along the lines marked with brilliant green solution. Traction on the three sutures is maintained by an assistant. Care must be taken at this point so that lateral dissection of the myometrium into the cornual area is avoided to prevent transection of the tube. The entire fibrous septum must be excised.

A row of 3-0 Dexon sutures is placed through the endometrium, closing the endometrium and the innermost layers of the myometrium.

The second row of 2-0 Dexon is used to close the myometrium with a mattress suture.

Figure 6 shows three layers of sutures: those on the myometrium, (a), those on the endometrium (b), and those on the serosa (c).

The completed operation is shown. Interrupted sutures in the serosa have been placed approximately 1 cm apart from the lower uterine segment of the opposite side.

This frontal section of the uterus shows the unified endometrial cavity. Sutures a, b and c have been placed as described in Step 6.

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