Robotic-assisted excision of an accessory cavitated uterine malformation with indocyanine green assessment of the uterine cavity

OBJECTIVE: To highlight the presentation and management of a patient with dysmenorrhea caused by an accessory cavitated uterine malformation (ACUM) while also summarizing the current evidence regarding this pathology. DESIGN: Video article demonstrating the presentation, investigations, and surgical management of patient with an ACUM. SUBJECTS: A 22-year-old patient presenting with severe cyclical pain that was refractory to medical treatment was managed at a tertiary minimally invasive gynecology and endometriosis center. Ultrasound and magnetic resonance imaging showed radiological features consistent with ACUM. After appropriate counseling, the patient decided to proceed with surgical management. INTERVENTION: Robotic-assisted laparoscopic excision of an ACUM. The aim was to completely excise the malformation with specific steps taken to minimize blood loss, including infiltration with vasopressin and placement of temporary vascular clips, as well as prevent entry into the uterine cavity/fallopian tube. There was an incidental finding of endometriosis, which was also excised during the procedure. MAIN OUTCOME MEASURES: Perioperative data, including complications, histology, and symptom change. RESULTS: Complete excision of malformation with uncomplicated procedure and recovery. Histology confirmed ACUM. At follow-up, the patient had complete resolution of presenting symptoms. CONCLUSION: This video article highlights the presentation of patient with typical features for ACUM, as well as a reproducible technique for the surgical management of this malformation. The information can be used by other clinicians managing individuals with this rare presentation.