Robot-Assisted Total Hysterectomy of Extremely Unusual Pelvic Anatomy: A Case Report and Literature Review.

Nagata H, Komatsu H, Nakaso T, Kudoh A, Azuma Y, Taniguchi F
Yonago acta medica · 2022 · doi:10.33160/yam.2022.11.003 · PMID:36474900 · PMC9691378
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This case report describes a safe robot-assisted total hysterectomy for lobular endocervical glandular hyperplasia in a patient with uterine didelphys and rare pelvic anatomy, highlighting the procedure's precision and intraoperative convenience.

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This case report describes a robot-assisted total hysterectomy performed on a patient with uterine didelphys and an extremely rare anatomical configuration where the sigmoid colon was interposed between the two uterine corpora. The surgical team utilized intraoperative magnetic resonance imaging to navigate this complex pelvic anatomy, ultimately completing the procedure safely for lobular endocervical glandular hyperplasia. The authors highlight that robotic surgery offers superior visualization and precision, which facilitated the safe management of these unusual structural anomalies. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

We report a case of robot-assisted total hysterectomy in a patient with extremely rare pelvic anatomy. Robot-assisted total laparoscopic hysterectomy was performed for lobular endocervical glandular hyperplasia on the left side of the uterus. The sigmoid colon was present between the two uterine corpora of a uterine didelphys and was attached to the bladder via the mesentery and fat. During surgery, the surgeon left the console and confirmed the magnetic resonance images. The surgery was then completed safely after the surgeon understood the anatomy. The postoperative condition was good, and the patient was discharged on postoperative day 5. Robot-assisted surgery has various advantages, including a good field of view, accuracy of instrument movement, and ease of viewing information in the medical record by pausing the operation. Robot assisted surgery improves not only safety and operational precision but also intraoperative convenience. Further studies are needed regarding the specific anatomy seen in this case.
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Keywords

anatomy, didelphic uterus, endocervical glandular hyperplasia, hysterectomy, robotic surgery 2022 Volume 65 Issue 4 Pages 315-319 Details

Abstract

We report a case of robot-assisted total hysterectomy in a patient with extremely rare pelvic anatomy. Robot-assisted total laparoscopic hysterectomy was performed for lobular endocervical glandular hyperplasia on the left side of the uterus. The sigmoid colon was present between the two uterine corpora of a uterine didelphys and was attached to the bladder via the mesentery and fat. During surgery, the surgeon left the console and confirmed the magnetic resonance images. The surgery was then completed safely after the surgeon understood the anatomy. The postoperative condition was good, and the patient was discharged on postoperative day 5. Robot-assisted surgery has various advantages, including a good field of view, accuracy of instrument movement, and ease of viewing information in the medical record by pausing the operation. Robot assisted surgery improves not only safety and operational precision but also intraoperative convenience. Further studies are needed regarding the specific anatomy seen in this case. © 2022 Tottori University Medical Press Favorites & Alerts Recently viewed articles

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