Hysteroscopic Management of Robert’s Uterus

Excerpt

Robert’s uterus is a rare type of Mullerian anomaly, a variant of septate uterus (Class V, American society for Reproductive medicine classification). It is also known as asymmetric septate uterus first reported by Robert in 1970. We report a case of a 16-year-old unmarried girl who presented to us with complaints of severe dysmenorrhea since one year not responding to treatment. MRI of pelvis revealed uterine septum dividing endometrial cavity asymmetrically into normal right-sided uterine cavity and left-sided non-communicating hemicavity (Fig. 1). Figure 2a shows laparoscopy findings preoperatively, and broad fundus is seen. Bulge is seen on the left side of fundus due to the collection of blood (hematometra) in the left side of uterine cavity due to asymmetric uterine septum. Figure 2b shows postoperative laparoscopic view of normal fundus after excision of uterine septum. Figure 3a shows that on hysteroscopic illumination of uterine cavity, only right-sided cavity was illuminated as left-sided cavity was obliterated due to hematometra due to asymmetric uterine septum Figure 3b shows that on hysteroscopic illumination of endometrial cavity, entire uterine cavity is illuminated after excision of uterine septum. Figure 4a shows that on hysteroscopy, right-sided cavity and ostia were visualized and left-sided septal bulge was seen due to asymmetric uterine septum. Figure 4b shows that on hysteroscopy, septum was excised using scissors. Hematometra of left side was drained, and the cavity was seen communicating with endometrial cavity. Figure 4c shows the hysteroscopic view of unified endometrial cavity after septal resection is shown.

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