Robotic Excision of Accessory Cavitated Uterine Mass

INTRODUCTION: An accessory cavitated uterine mass (ACUM) is a noncommunicating, accessory uterine cavity in the absence of other obstructive congenital uterine anomalies. Common symptoms include dysmenorrhea, noncyclic pelvic pain, dyspareunia, and abnormal uterine bleeding. While medical management in the form of menstrual suppression is aimed at decreasing symptoms, up to 80% of patients with this congenital finding have continued symptoms despite medical treatment. Thus, surgical management in the form of excision is considered definitive treatment, and typically occurs in either a laparoscopic or robotic fashion. This patient is a 34-year-old with a history of dysmenorrhea and pelvic pain who was found to have a uterine lesion concerning for an ACUM on MRI imaging and desired definitive management in the form of surgical excision. OBJECTIVE: Review the definition and differentials of an ACUM as a spectrum of congenital uterine anomalies. Highlight surgical techniques for successful excision of an ACUM in patients desiring fertility preservation. METHODS: This is a surgical video presentation of a robotic approach to an excision of an accessory cavitated uterine mass. RESULTS: This video highlights a robotic approach to the excision of an ACUM. Key surgical principles include opening of the anterior and posterior broad ligaments to isolate the mass, careful dissection to preserve surrounding structures such as the fallopian tube and uterine vessels, and retroperitoneal dissection of nearby anatomic structures such as pelvic sidewall vasculature and the ureter. The use of dilute vasopressin and a vessel sealing device can be utilized to help minimize blood loss. This video also provides an overview of preoperative diagnosis and postoperative care. CONCLUSIONS: An ACUM should be on the differential for patients presenting with dysmenorrhea and a uterine lesion noted on advance imaging. Surgical excision should be considered for the definitive management of symptoms or for those patients not responsive to medical management.