Robotic-Integrated Intraoperative Ultrasound for Excision of Accessory Cavitated Uterine Malformation (ACUM): An Innovative Surgical Technique

Robotic-Integrated Intraoperative Ultrasound for Excision of Accessory Cavitated Uterine Malformation (ACUM): An Innovative Surgical Technique | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Robotic-Integrated Intraoperative Ultrasound for Excision of Accessory Cavitated Uterine Malformation (ACUM): An Innovative Surgical Technique Smitha Priyadarshini Thippeswamy¹, Radwa Hablase¹, Joydeep Chatterjee, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8631036/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 7 You are reading this latest preprint version Abstract ACUM is a rare Mullerian anomaly in young women, who typically present with refractory dysmenorrhea. Though pre-operative 3D ultrasound and MRI are gold standards for identification of this condition, diagnostic accuracy and delay presents challenges for appropriate early management of this rare condition. Due to the deep intra-myometrial location of this anatomical variation, the necessity of precise excision presents a surgical hurdle in aiming to preserve healthy myometrium. We describe an innovative surgical robotic technique in the management of ACUM in a 22-year-old nulliparous woman who presented with incapacitating cyclical pelvic pain. This novel technique enables the utilization of robotic-integrated intraoperative ultrasound (drop-in probe) that facilitates real-time identification of the lesion margins, vascular mapping and ensures complete excision of the lesion. This technique minimizes loss of healthy myometrium and helps maintain integrity of the endometrial cavity. The patient reported complete symptom resolution postoperatively. The integration of real-time intraoperative ultrasound within the robotic platform enhances surgical precision by minimizing the surgical trauma and potentially improves reproductive outcomes. Accessory cavitated uterine mass ACUM robotic surgery intraoperative ultrasound Müllerian anomaly dysmenorrhea Full Text Additional Declarations Competing interest reported. Professor Jayanta Chatterjee: is a proctor for Intuitive Surgical Ltd, the manufacturer of Da VinciTM surgical robots. As such, he has received payment and travel expenses within the past three years for surgical proctoring of robotic gynaecological surgery at hospitals around the UK and Europe, as he is an acknowledged global expert in this field. He also gives paid educational lectures on behalf of pharmaceutical companies. Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Accepted 04 Mar, 2026 Reviews received at journal 22 Feb, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers invited by journal 28 Jan, 2026 Editor assigned by journal 25 Jan, 2026 Submission checks completed at journal 23 Jan, 2026 First submitted to journal 18 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8631036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":582033192,"identity":"6ade228b-1482-485a-b4d2-ec0615f7f563","order_by":0,"name":"Smitha Priyadarshini Thippeswamy¹","email":"","orcid":"","institution":"Royal Surrey County Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Smitha","middleName":"Priyadarshini","lastName":"Thippeswamy¹","suffix":""},{"id":582033193,"identity":"9e6417bd-f404-4f09-85fd-f52123c69c5c","order_by":1,"name":"Radwa Hablase¹","email":"","orcid":"","institution":"Royal Surrey County Hospital NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Radwa","middleName":"","lastName":"Hablase¹","suffix":""},{"id":582033194,"identity":"c33d6c5e-0450-48f9-9523-b60efd0089e7","order_by":2,"name":"Joydeep Chatterjee","email":"","orcid":"","institution":"Imperial College London","correspondingAuthor":false,"prefix":"","firstName":"Joydeep","middleName":"","lastName":"Chatterjee","suffix":""},{"id":582033195,"identity":"afa2c79a-a61f-4046-a6b6-919baf64be97","order_by":3,"name":"Raef Faris","email":"","orcid":"","institution":"Lister Hospital","correspondingAuthor":false,"prefix":"","firstName":"Raef","middleName":"","lastName":"Faris","suffix":""},{"id":582033196,"identity":"fe5aeb76-8d98-4b72-ae89-6b3c1c95bee7","order_by":4,"name":"Priya Narayanan","email":"","orcid":"","institution":"University College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Priya","middleName":"","lastName":"Narayanan","suffix":""},{"id":582033197,"identity":"441eeb22-eba8-45a2-ade7-d1e9636f8436","order_by":5,"name":"Jayanta Chatterjee¹","email":"data:image/png;base64,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","orcid":"","institution":"Royal Surrey County Hospital NHS Foundation Trust","correspondingAuthor":true,"prefix":"","firstName":"Jayanta","middleName":"","lastName":"Chatterjee¹","suffix":""}],"badges":[],"createdAt":"2026-01-18 11:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8631036/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8631036/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-026-08395-2","type":"published","date":"2026-03-19T15:58:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":105224171,"identity":"65852184-c3c2-4305-8afd-e2685f25c3ac","added_by":"auto","created_at":"2026-03-23 16:12:58","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":527641,"visible":true,"origin":"","legend":"","description":"","filename":"ACUMmanuscriptforArchivesofobstetricsandGynecology.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8631036/v1_covered_a2b5ab51-39c8-4bd7-a687-304722f884a7.pdf"}],"financialInterests":"Competing interest reported. 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