Published in:
01-11-2016 | Short Communication
Management of Robert’s uterus by combined hysteroscopic and laparoscopic management: a clinical pearl
Published in: Gynecological Surgery | Issue 4/2016
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Table 1
Salient features of obstructive type of complex mullerian anomalies
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Traits
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Robert’s uterus
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Unicornuate uterus with non communicating rudimentary horn with functional endometrium
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Bicornuate uterus(obstructive type)
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|---|---|---|---|
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Age at presentation
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16–19 years, (post menarche)
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Postmenarche /pregnancy complications
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Reproductive age group
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Clinical features
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Ipsilateral progressive dysmenorrhea following menarche
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Ipsilateral progressive dysmenorrhea following menarche
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Ipsilateral progressive dysmenorrheal following menarche , Complications related to pregnancy
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Uterine Cavity
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Asymmetrical, completely obstructing septum on one side
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Hemiuterus with fixed rudimentary horn.
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Two cavities are separated by muscular myometrium
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Isthmus
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Well developed
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Absent on the rudimentary half
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Present
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|
Cervix
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Ipsilateral cervical aplasia
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Well developed
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Well developed, unicollis/bicollis
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Vagina
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Septum +/−
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Normal
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Septum present , of obstructive variety
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Imaging findings
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The external contours of the uterus are normal. On a coronal section the fundal serosa is rectilinear or with mild invagination (less than 1 cm). The single uterine cavity is divided by a bridge of fibrous myometrium. The septum is generally hypovascularized in comparison to the adjacent myometrium.
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A deviated uterus to one side, with spindle-shaped aspect of the cavity is easier recognized by 3D sonography, MRI or hysterosalpingography.
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Two cavities with one or two cervix with obstructed hemi vagina
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Hysteroscopy
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Tubular cavity with a single ostium, complete septa covering the hemicavity
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Banana-shaped cavity
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Two cavities with respective ostia and vaginal septa
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Laparoscopy
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Broad fundus with bulge on obstructed side
Normal tubes and ovaries, sometimes rudimentary on ipsilateral side
Evidence of hematometra
Ipsilateral endometriosis
Indentation of fundus by white line due to underlying septa
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Single fundus
Normal tubes and ovaries, sometimes rudimentary on ipsilateral side
Evidence of hematometra
Ipsilateral endometriosis
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Two different fundi with a band between them
Normal tubes and ovaries
No hematometra
No endometriosis
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|
Renal anomalies
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Absent
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Present/absent
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Present/absent
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Treatment
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Hysteroscopic septal resection (first choice).
If surgeon is unable to resect the septa for any reason, excision of the other half can be done (second choice)
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Laparoscopic excision of the rudimentary horn with ipsilateral salpingectomy to prevent ectopic
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In cases of bad obstetric history, requires surgical intervention.
Vaginal septal resection
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|
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