This chapter discusses surgical management of a uterine septum, where hysteroscopic septum resection is a safe and effective method for patients with history of infertility or recurrent miscarriage. Uterine anomalies result from a defect in the development or fusion of the paired Müllerian ducts during embryogenesis, and are the most common types of malformations of the female reproductive system. Diagnosis is established with hysterosalpingography, MRI, and ultrasound. Transvaginal ultrasonography is more accurate. Hysteroscopic metroplasty in women with a septate uterus and infertility improves the clinical pregnancy and live birth rates in patients. Operative hysteroscopy may be performed using monopolar or bipolar electrosurgery. Bipolar electrosurgery uses isotonic saline as distention medium and may be safer and more effective for hysteroscopic surgery compared to monopolar electrosurgery. The lower live birth rate after metroplasty makes it questionable to perform correction of the uterine septum, as these patients may benefit from concentrating on other infertility treatments.