Miguel Caceres
Pacifica Salud Hospital , PanamaPresentation Title:
Robot-Assisted (Hugo) laparoscopic left hemi-hysterectomy in patient with Helyn-Werner-Wunderlich syndrome and left hysterometry
Abstract
Introduction:
Herlyn-Werner-Wünderlich syndrome (HWW) is a rare Müllerian anomaly
characterized by the triad: uterus didelphys, blind hemivagina and ipsilateral
renal agenesis. Disabling dysmenorrhea is the main symptom, presenting a few
months after menarche. Other symptoms include pelvic mass and pressure.
Treatment focuses on relieving symptoms or preserving fertility. Hysteroscopic
vaginal septotomy relieves dysmenorrhea. To preserve fertility, a resection of
the affected hemiuterus is performed using laparoscopic or abdominal surgery
and in this case, robotic surgery with the HUGO system. We present the world's
first case of robotic-assisted hemi-hysterectomy with the HUGO-RAS
Clinical case: 19-year-old
patient, G0, with a history of left renal agenesis, menarche for 11 years,
regular cycles. A year ago, with symptoms of severe dysmenorrhea. Physical
examination: normal external genitalia, USG with presence of right hemi-uterus,
with cervix permeable to vagina, approximately 6.0 x 4.0 cm and trilaminar
endometrium; the left hemi-uterus with hematometra of approximately 150 cc and
lack of communication towards the vaginal canal. It is complemented by MRI,
which confirms the diagnosis of Herlyn-Werner-Wünderlich Syndrome. HUGO
robot-assisted laparoscopic hemi-hysterectomy was performed to resolve
hematometra and preserve fertility.
Discussion:
Herlyn-Werner-Wunderlich syndrome is a rare uterine malformation (uterus
didelphys) with ipsilateral renal agenesis. It presents with dysmenorrhea,
pelvic pain, pelvic tumor, infertility, etc. The diagnosis is made by pelvic
ultrasound and magnetic resonance imaging. The treatment of choice is resection
of the vaginal septum by hysteroscopy to preserve fertility. In complex cases,
hemi-hysterectomy or total hysterectomy is performed. Robot-assisted
laparoscopic hemi-hysterectomy offers less postoperative pain, shorter hospital
stay, better recovery, better three-dimensional vision and control for
dissection, and greater ergonomics for the surgeon. In cases with distorted
anatomy, robotic technology offers significant advantages. We present the
world's first case of robotic-assisted hemi-hysterectomy with the HUGO-RAS in a
patient with didelphys uterus and left renal agenesis, without complications.
The HUGO system has artificial intelligence, which is an important complement
to the successful handling of these cases and their respective feedback. Early
diagnosis and treatment are important to avoid acute and chronic complications,
improving the patient's quality of life. This case provides evidence on the
usefulness of robotic surgery in the management of this pathology.
Conclusion: The case
presented illustrates the potential of robotic surgery as an effective
therapeutic alternative in the management of uterus didelphys. The patient
experienced a satisfactory recovery and a notable improvement in her quality of
life, which supports the effectiveness of this approach. The combination of
strategic trocar placement, precise configuration of robotic arms and the
capabilities of HUGO RAS software combined with artificial intelligence, allows
complex gynecological surgeries to be performed with greater precision, safety
and effectiveness.
Biography
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