Management of Robert’s uterus by combined hysteroscopic and laparoscopic management: a clinical pearl

Ramesh, B; Chaithra, T. M.; Desai, Harita R.; Ghanti, Rachana; Daksh, Shraddha

doi:10.1007/s10397-016-0954-4

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Hence, if it is decided for ipsilateral salpingectomy, judicious use of cautery is emphasised to avoid any thermal insult to the ovary. Hysteroscopic metroplasty has been used by some authors as a cavity expansion procedure that involves resection of the septum[ 13 15 19 20 26 29 ] under USG guidance, followed by anti-adhesiolysis therapy such as hormone replacement therapy, intrauterine contraceptive device or sequential balloon therapy. [ 14 ] Septal thickness might play a crucial role in hysteroscopic metroplasty as thick and muscular septa are difficult to cut and may cause a recurrence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Robert's Uterus Versus Juvenile Cystic Adenomyoma – Diagnostic and Therapeutic Challenges – Case Report and Review of Literature

Mahey

Cheluvaraju

Kumari

et al. 2023

Journal of Human Reproductive Sciences

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A BSTRACT This case report highlights the diagnostic dilemma and therapeutic challenges encountered while managing adolescent girls with progressive dysmenorrhoea and management of Robert's uterus. Two girls aged 20 years and 13 years presented with severe progressive dysmenorrhoea. In the first case, laparoscopy revealed juvenile cystic adenomyoma (JCA) of 3 cm × 3 cm on the left side anteroinferior to the round ligament. Laparoscopic resection of the lesion was done, and histopathology revealed features of adenomyosis. In the second case, there was a globular enlargement of the right half of the uterine body with round ligament and adnexa attached to the lesion (Robert's uterus). In view of severe symptoms, complete resection of the lesion and partial resection of hemi-uterus was done, followed by myometrial defect closure. Both cases were initially diagnosed as JCA, and the final diagnosis was made on laparoscopy. Both girls had complete symptomatic relief from the next menstrual cycle and have been under follow-up for 24 months and 18 months, respectively. Due to the rarity of conditions, Robert's uterus and JCA are usually misdiagnosed with each other or with other Mullerian anomalies such as a non-communicating unicornuate uterus. Radiologists and clinicians should be aware of these different pathologies causing similar symptoms. Understanding the pathology, early diagnosis, timely referral and correct surgical procedure are emphasised to improve reproductive outcomes.

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Section: Discussionmentioning

confidence: 99%

Robert's Uterus Versus Juvenile Cystic Adenomyoma – Diagnostic and Therapeutic Challenges – Case Report and Review of Literature

Mahey

Cheluvaraju

Kumari

et al. 2023

Journal of Human Reproductive Sciences

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“…In our case, MRI and intra-abdominal findings revealed a slightly concave uterine fundus, which we misdiagnosed as a unicornuate uterus with a non-communicating rudimentary horn and hematometra because we had no knowledge of this disease at that time. Consequently, we performed laparoscopic resection of the non-communicating rudimentary uterus (i.e., hemiuterus in this case) with ipsilateral salpingectomy to prevent future ectopic pregnancy and rupture of the pregnant horn [ 14 , 15 ]. Importantly, to accurately diagnose and differentiate this entity from other similar uterine malformations, knowledge of this rare disease and the various diagnostic approaches such as MRI, US, hysteroscopy, and laparoscopy are essential.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrence of hematometra can be prevented via complete excision of the obstructed cavity with preservation of the normal cavity, or via unification of both uterine cavities by incising the septum. Previously, the most common treatments for Robert’s uterus were laparoscopic or laparotomic resection of the hemi-uterus, or endometrectomy of the blind cavity [ 14 , 16 – 19 ]. However, hysteroscopic metroplasty with US and laparoscopic guidance has recently become the first choice of treatment owing to its good outcomes due to its relative safety and low invasiveness.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

et al. 2021

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Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

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Müllerian anomalies and endometriosis: associations and phenotypic variations

Bhamidipaty-Pelosi,

Kyei-Barffour,

Volpert

et al. 2024

Reprod Biol Endocrinol

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Müllerian anomalies are congenital conditions characterized by the incomplete development of the female reproductive tract. Women affected by Müllerian anomalies often display additional malformations of the renal, skeletal, and cardiovascular system, and are at a higher risk for infertility and adverse pregnancy outcomes. Several Müllerian anomalies have been reported in association with endometriosis, but it is unclear if all classes or anatomical variations are associated with the disease. Most importantly, both Müllerian anomalies and endometriosis can manifest with a wide degree of variability, adding further complexity to their poorly defined relationship. Retrograde menstruation occurring in obstructive Müllerian anomalies is a well-accepted mechanism for the development of endometriosis. However, endometriosis can occur following surgical correction of the anomaly or in the absence of obstruction. This suggests that other mechanisms may be involved, although the specific pathogenesis remains elusive. This review provides a comprehensive summary of the current state of clinical research on endometriosis in Müllerian anomalies. This review also highlights research and knowledge gaps, informing the development of future experimental designs to address current limitations including heterogeneity of phenotypes, variable comorbidities, and lack of genetic information.

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Management of Robert’s uterus by combined hysteroscopic and laparoscopic management: a clinical pearl

Cited by 3 publications

References 6 publications

Robert's Uterus Versus Juvenile Cystic Adenomyoma – Diagnostic and Therapeutic Challenges – Case Report and Review of Literature

Robert's Uterus Versus Juvenile Cystic Adenomyoma – Diagnostic and Therapeutic Challenges – Case Report and Review of Literature

Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

Müllerian anomalies and endometriosis: associations and phenotypic variations

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