Unifying the Divided: Hysteroscopic Treatment of Robert’s Uterus, a Rare Congenital Challenge

Abstract

Study Objective

To describe a minimally invasive hysteroscopic approach for the diagnosis and treatment of Robert’s uterus, a rare congenital uterine anomaly, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine profile.

Design

Stepwise demonstration with video footage of the first miniminally invasive, ultrasound-guided, fully hysteroscopic treatment of Robert’s uterus performed using a 15 Fr bipolar miniresectoscope.

Setting

Digital Hysteroscopic Clinic of the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Patients or Participants

A 30-year-old woman diagnosed with Robert’s uterus presenting with symptoms related to obstructed uterine anomaly.

Interventions

The patient underwent a fully hysteroscopic unification of the uterine cavity. Under transabdominal ultrasound guidance, a 15 Fr mini-resectoscope with a Collins loop was used to progressively incise the uterine septum, establish communication between the hemicavities, and normalize the uterine architecture.

Measurements and Primary Results

Postoperative 3D ultrasound confirmed successful unification of the uterine cavity with normalization of intrauterine anatomy. No perioperative complications occurred, and the patient was discharged three hours after the procedure.

Conclusion

Robert’s uterus can be effectively managed through a minimally invasive, hysteroscopic approach using a 15 Fr bipolar mini-resectoscope, under transabdominal ultrasonographic guidance. This technique offers a safe and efficient alternative to more invasive surgical options.