Design: A descriptive video series detailing the surgical approach for myomas located within the septum of a septate uterus and a second look procedure conducted 45-60 days post-operation.

Setting: Procedures were performed in an operating room setting, with the first two cases under sedation and the third under general anesthesia due to concurrent videolaparoscopy. Procedures were performed in a gynecological position.

Patients or Participants: Three nulliparous women with unique clinical histories: the first with infertility, the second desired to discontinue hormonal therapy for a potential pregnancy, and the third was scheduled for videolaparoscopy due to endometriosis. Imaging investigations revealed a partial septate uterus (Class U2A - ESHRE / ESGE classification) with a fibroid hidden in the septum.

Interventions: Diagnostic hysteroscopy identified the septum and both tubal ostia. Different surgical tools were utilized across cases, including a 16-Fr mini-resectoscope and 26-Fr resectoscope. Saline solution was used as the distension media at a pressure of 80 mmHg. Metroplasty was performed and during the resection of the uterine septum, the presence of fibroids was observed in all cases, hidden in the middle of the septum. Myomas' pseudocapsules were identified, isolated, and myomectomy was performed to remove the myoma. Different techniques were used, including using a bipolar cutting loop or cutting the fibroid in half similar to morcellation.

Measurements and Main Results: Procedures were successful, and patients were discharged on the same day. The second look showed only a small synechiae in the fundus of the uterus, which were released with scissors without energy use.

Conclusion: The septate uterus is the most frequent Müllerian anomaly. Leiomyomas within the uterine septum are rare, and their management through hysteroscopic techniques is crucial for restoring uterine anatomy and function. Second-look hysteroscopy should be scheduled 45-60 days after.