Video presentation of diagnosis and management of Robert’s uterus

Robert’s uterus is an extremely rare Mullerian duct malformation which is characterized by a septate uterus with obstruction of one of the cavities. The three triads of Robert’s uterus include Blind hemicavity/uterine horn with hematometra, Contralateral Unicornuate uterine cavity and normal uterine fundus with a small indentation.  Only a few cases are reported in the literature since it’s first diagnosis by Robert’s in 1970.

Patients usually present with severe dysmenorrhea at the time of menstruation because of accumulation of menstrual blood in the non-communicating horn, reproductive failure, and dyspareunia. Three different type of Robert’s Uteri have been described: Type 1 is with large hematometra, Type 2 is with no hematometra while Type 3 is with small hematometra.

Classification of this anomaly is debatable, the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE‐ESGE) classification describes this anomaly as a complete septate uterus with partial cervical aplasia; however, no explanation is given for diagnosing ‘unilateral cervical aplasia.’ The American Society of Reproductive Medicine classification system classifies it as a rare obstructive form of class VB anomalies.

Diagnosis is made based on history, physical examination and a combination of modern imaging techniques like 3D sonography, MRI, three‐dimensional sonohysterography with volume‐contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC). HSG is often misleading and only depicts the Unicornuate horn.

Previous treatments include invasive horn resection surgery or endometrectomy via laparoscopy or laparotomy, which resulted in a loss of normalization of uterine volume and shape, abdominal metroplasty or by combining hysteroscopy/laparoscopy.

This video demonstrates successful management of all three types of Robert’s uterus using:

• Three-dimensional (3D) ultrasound in diagnosing and surgical management
• Hysteroscopic metroplasty transrectal ultrasound guidance
• Sequential balloon therapy to prevent adhesions
• Three-dimensional ultrasound for postoperative assessment of the cavity

In the end, a successful unification of non-communicating and communicating uterine cavity parts during surgery, better shape and several times higher volume of the uterine cavity, and total elimination of pain associated with obstruction after healing period were recorded.

Abstract

Here is the video presentation of Pre-, Intra- and Postoperative Management of Robert's Uterus