Hysteroscopic Repair of Robert's UterusUnifying the Divided: Hysteroscopic Treatment of Robert's Uterus, a Rare...

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

Digital Hysteroscopic Clinic - CLASS Hysteroscopy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

A 30-year-old woman with symptomatic obstructed müllerian anomaly diagnosed as Robert's uterus.

A one-stop hysteroscopic approach was performed in a single session, combining 2-dimensional (2D) transvaginal ultrasound with 3-dimensional (3D) reconstruction of the uterine anatomy, followed by diagnostic hysteroscopy using a 5 mm hysteroscope, thus avoiding the need for magnetic resonance imaging (MRI). This integrated 3D ultrasound and hysteroscopic assessment enabled definitive diagnosis of Robert's uterus. Operative hysteroscopy under general anesthesia (laryngeal mask) was subsequently performed using a 15 Fr bipolar mini-resectoscope. Hysteroscopic unification of the unicornuate cavity and blind horn was achieved by progressive latero-lateral septal incision with a Collins loop under transabdominal ultrasound guidance, establishing communication between the cavities. The septum was incised up to the interostial plane, and the right uterine wall was further incised to enlarge the cavity. A 90° angled loop was then used to remove redundant tissue, restoring normal uterine architecture. Postoperative 3D ultrasound confirmed successful unification. No peri- and/or post-operative complications occurred. The patient was discharged 3 hours after surgery. Outpatient hysteroscopic follow-up at 35 days showed a normally shaped uterine cavity.

Robert's uterus can be effectively and safely managed through a minimally invasive hysteroscopic approach [1-3] using a 15 Fr bipolar mini-resectoscope under transabdominal ultrasonographic guidance. This technique provides a safe, efficient alternative to more invasive surgical options. Further larger studies are required to validate the surgical technique and assess long-term reproductive outcomes.