Mullerian ducts anomalies (MDA) have been historically connected to bad obstetric prognosis characterized by a recurrent miscarriage, preterm delivery, abnormal fetal presentation and fetal or perinatal complications [
3]. There are several techniques available for uterine malformations evaluation, office hysteroscopy is particularly useful to evaluate uterine cavity, while transvaginal ultrasound with 3D technique and the use of contrast can evaluate the uterine external morphology, the cavity and the tubes [
6]. Ultrasound is easily reproducible and less expensive than magnetic resonance and it can be considered as the gold standard. The development of both the hysteroscopic technique in an outpatient setting and the 3D ultrasound, has increased the knowledge on MDA and has allowed development of new strategies in the treatment of MDA. The calculation of endometrial volume has not been previously studied as a diagnostic factor able to evaluate the success of the hysteroscopic procedure, but can easily and objectively measure the increase in the volume after removing the septa. According to ASRM guidelines, there are no sufficient proofs to recommend any specific method for hysteroscopic septum removal, and there are no randomized studies that showed which surgical technique can be preferred to improve the outcomes [
6,
19]. However, some studies have shown that the metroplasty can improve the pregnancy outcomes in women with a history of infertility and miscarriages [
20]. Our surgical technique consists in the surgical removal of the septum, and not in the simple opening of the septum as the traditional technique. These techniques have already shown good clinical outcomes in our previous experience with laser [
12,
21]. In addition, recently, Haimovich et al. confirmed our preliminary results on hysteroscopic metroplasty with a diode laser. Tissue vaporization and coagulation with low power diode laser energy allow the quick elimination of the uterine septum without affecting the underlying myometrium [
22]. The septum should be considered as a solid foreign body in the uterine cavity, surrounded by healthy myometrium, as confirmed in the most recent literature [
23]. Because of its anatomopathological nature of leiomuscular tissue, a septum should be potentially treated as a myoma. In conclusion, diode laser is a feasible and safe alternative to the scissor, bipolar twizzle, and bipolar or monopolar resectoscope techniques. It allows the vaporization of the uterine septum demonstrating extreme precision of cutting, precise control of tissue vaporization, controlled power of penetration, a high capacity of hemostasis, the absence of electrical interferences, high safety, and good compliance of patients due to office setting without the need for cervical dilatation [
24‐
26]. Among the limitations of our study we can include the relatively small number of the sample and the lack of a control group. A potential side effect of our technique could be the weakening of the uterine walls because of the removal of the septum, that might potentially have a negative effect on the pregnancy and a spontaneous delivery; therefore, further larger randomized studies are necessary to correlate our positive first clinical data to obstetric outcomes.