Robotic-Integrated Intraoperative Ultrasound for Excision of Accessory Cavitated Uterine Malformation (ACUM): An Innovative Surgical Technique

ACUM is a rare Mullerian anomaly in young women, who typically present with refractory dysmenorrhea. Though pre-operative 3D ultrasound and MRI are gold standards for identification of this condition, diagnostic accuracy and delay presents challenges for appropriate early management of this rare condition. Due to the deep intra-myometrial location of this anatomical variation, the necessity of precise excision presents a surgical hurdle in aiming to preserve healthy myometrium. We describe an innovative surgical robotic technique in the management of ACUM in a 22-year-old nulliparous woman who presented with incapacitating cyclical pelvic pain. This novel technique enables the utilization of robotic-integrated intraoperative ultrasound (drop-in probe) that facilitates real-time identification of the lesion margins, vascular mapping and ensures complete excision of the lesion. This technique minimizes loss of healthy myometrium and helps maintain integrity of the endometrial cavity. The patient reported complete symptom resolution postoperatively. The integration of real-time intraoperative ultrasound within the robotic platform enhances surgical precision by minimizing the surgical trauma and potentially improves reproductive outcomes.