Design: N/A

Setting: This case was one of the first cases performed in Australia on the HUGO-RAS robot.

Patients or Participants: N/A

Interventions: The patient was consented for a robotic hysterectomy and bilateral salpingectomy

Measurements and Main Results: We will present the surgical video highlighting our surgical approach for this UD. A recto-vesical ligament between the two uteri is present and is a rare anatomical structure present in some Mullerian anomalies. The retroperitoneal pelvic mass that is resected was sent for histopathology which confirmed that it was a benign leiomyoma. The steps to the hysterectomy is similar to a single uterus however a key step is to ensure the uterine manipulator is utilised effectively throughout the case on each uterine horn. This case was performed with the HUGO-RAS system with an assistant Air-Seal port; which is crucial after a double colpotomy to maintain pneumoperitoneum. The on-console time was 55 minutes. A cystoscopy was performed which was unremarkable and the patient made a complete recovery with no complications.

Conclusion: This case is a rare presentation of multiple pathologies/abnormalities. It highlights the importance of understanding anatomy, haemostasis, and pre-operative and intra-operative planning. Moreover, the HUGO-RAS system performed well even though it is relatively new to the robotic surgical space.