Laparoscopic Excision of an Accessory Cavitated Uterine Malformation in an Adolescent Patient.

OBJECTIVE

To demonstrate the laparoscopic, uterus-sparing excision of an accessory cavitated uterine malformation (ACUM) in an adolescent patient, with particular emphasis on the challenges of intraoperative localization and the role of accurate preoperative imaging [1,2].

DESIGN

Educational video article demonstrating step-by-step laparoscopic management.

SETTING

Tertiary referral center for minimally invasive gynecologic surgery.

PATIENT: An 18-year-old, sexually inactive adolescent presenting with severe dysmenorrhea and chronic pelvic pain refractory to medical treatment.

INTERVENTION: Laparoscopic excision of a noncommunicating accessory cavitated uterine lesion while preserving the main uterine cavity.

MAIN OUTCOME MEASURES: Successful identification and complete excision of the lesion, preservation of uterine integrity, symptom resolution, and histopathological confirmation of diagnosis.

RESULTS

Preoperative transabdominal ultrasonography and magnetic resonance imaging demonstrated a 35 × 43 mm cystic lesion located in the left anterior wall of the uterus, clearly separated from the endometrial cavity and consistent with ACUM. During laparoscopy, the uterus, fallopian tubes, and ovaries appeared normal, and no obvious uterine bulging was observed, making intraoperative localization challenging. A targeted myometrial incision was performed, and the cystic lesion was identified, opened, and completely excised. Chocolate-colored fluid was drained from the cavity, which was lined with endometrium-like tissue. The main uterine cavity was not entered, and the myometrium was reconstructed in layers. Histopathological examination confirmed the diagnosis of ACUM [3]. The postoperative course was uneventful. At 6-month follow-up, the patient reported complete resolution of symptoms without the need for analgesics.

CONCLUSION

ACUM should be considered in adolescent patients presenting with severe dysmenorrhea and a cystic uterine mass [4]. Laparoscopic, uterus-sparing excision is a safe and effective treatment option, even when intraoperative identification of the lesion is technically challenging. Accurate preoperative evaluation is crucial, especially when the uterine mass is not externally apparent at laparoscopic inspection. VIDEO ABSTRACT.