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.
Fig. 1.
MRI of pelvis showing uterine septum dividing endometrial cavity asymmetrically into normal right-sided uterine cavity (red arrow) and left-sided (yellow arrow) non-communicating endometrial cavity
Fig. 2.
a Laparoscopy findings pre-excision of uterine septum. Bulge is seen on the left side of fundus due to hematometra on the left side of uterine cavity. b Postoperative laparoscopic view of normal fundus after excision of uterine septum
Fig. 3.
a Hysteroscopic illumination of uterine cavity; right half of cavity is illuminated as left side is obliterated due to hematometra. b Postexcision of uterine septum entire uterine cavity is illuminated
Fig. 4.
a On hysteroscopy right-sided cavity and ostia are visualized and left-sided septal bulge is seen due to asymmetric uterine septum. b Uterine septum is excised using scissors. Left-sided hematometra is drained. c Hysteroscopic view of unified endometrial cavity after septal resection
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Dr. Nitin Shah
has done his undergraduation and postgraduation from Seth. G.S.M.C and K.E.M. Hospital. At present, he is working as Consultant Gynaec Laparoscopic Surgeon. He is the Director of Vardann Multispeciality Hospital, Poisar, Kandivali West, Mumbai. He is Scientific Secretary of A.F.G. and Managing Committee Member of I.A.G.E. He is the holder of 10 world records for his laparoscopic surgeries. He is recipient of Golden Hand Award. He has published the highest number of cover page laparoscopic photo articles in J.O.G.I. He has more than 50 publications both national and international to his credit. He has won various awards and prizes at many national and international conferences.
Authors Contributions
Dr. NS has operated this case, searched the literature and done final proof reading of this article. Dr. PC who has done fellowship in laparoscopy under Dr. Nitin Shah has assisted this case, written this article, done literature search and helped in proof reading this article.
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Conflict of interest
The authors declare that they have no conflict of interest.
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We, the authors, hereby declare that we have taken the informed consent from the patient.
Footnotes
Nitin Shah is a Director at Vardann Multispeciality Hospital, Mumbai; Pradnya Changede is a Assistant Professor at Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai.
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