Robotic-integrated intraoperative ultrasound for excision of accessory cavitated uterine malformation (ACUM): an innovative surgical technique

Abstract

Background: Accessory cavitated uterine mass (ACUM) is a rare Mullerian anomaly that predominantly affects young women, presenting with refractory dysmenorrhea. Despite 3D ultrasound and MRI being the gold standard for diagnosis, diagnostic delays and accuracy limitations continue to hinder timely management. The deep intra-myometrial location of this anomaly poses significant surgical challenges in achieving complete excision while preserving healthy myometrium. Case Presentation: A 22-year-old nulliparous woman presented with incapacitating cyclical pelvic pain and was diagnosed with ACUM. She underwent surgical management using a novel robotic-assisted technique. Technique: The procedure utilised robotic-integrated intraoperative ultrasound via a drop-in probe, enabling real-time identification of lesion margins, vascular mapping, and confirmation of complete lesion excision. This approach minimised loss of healthy myometrium and preserved endometrial cavity integrity. Outcome: The patient reported complete symptom resolution postoperatively. Integration of real-time intraoperative ultrasound within the robotic platform enhanced surgical precision, reduced surgical trauma, and has the potential to improve reproductive outcomes. Conclusion: Robotic-assisted excision of ACUM with intraoperative ultrasound guidance represents an innovative and precise surgical technique. This approach addresses the key challenges of lesion localisation and myometrial preservation, offering a promising strategy for managing this rare condition in women of reproductive age.