Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert's Uterus

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Laparoscopic transillumination guided hysteroscopic metroplasty successfully simplified the surgical management of a challenging Type II Robert's uterus in a young nulliparous woman.

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Abstract

Robert's uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert's uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.
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Abstract

Robert’s uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert’s uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.

References

Robert H. Asymmetrical bifidities with unilateral menstrual retention (apropos of l2 cases). Chir Memoires Acad Chir. 1970;96(11):796–9. Di Spiezio SA, Campo R, Gordts S, et al. The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Hum Reprod. 2015;30(5):1046–58. Ludwin A, Ludwin I, Bhagavath B, et al. Pre-, intra-, and postoperative management of Robert’s uterus. Fertil Steril. 2018;110(4):778–9. Ludwin A, Ludwin I, Martins WP. Robert’s uterus: modern imaging techniques and ultrasound-guided hysteroscopic treatment without laparoscopy or laparotomy: New imaging techniques for Robert’s uterus. Ultrasound Obstet Gynecol. 2016;48(4):526–9. Funding None. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Informed consent Informed consent was taken from the patient. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dr. Akshita Panwar MD, Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India; Dr. Kusum Lata MD, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences New Delhi, India; Dr. Isha Kriplani MS, Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India; Dr. Seema Sharma MS, Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India; Dr. Alka Kriplani MD, Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India. Rights and permissions About this article Cite this article Panwar, A., Lata, K., Kriplani, I. et al. Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert’s Uterus. J Obstet Gynecol India 72 (Suppl 2), 421–424 (2022). https://doi.org/10.1007/s13224-021-01609-4 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13224-021-01609-4

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