2728 Robotic Assisted Excision of a Uterine Rudimentary Horn

Abstract

Video Objective The objective of this video is to portray a robotic assisted removal of a uterine rudimentary horn and excision of endometriosis in a patient with a Mullerian anomaly and dysmenorrhea. Setting The patient is a 32 year old G2P1001 who presented with a 6 month history of worsening dysmenorrhea with multiple emergency department visits secondary to pain. Patient has a history of a prior uncomplicated full-term delivery via cesarean section 1 year prior and a laparoscopic appendectomy, with a different provider, where a right salpingo-oophorectomy was performed. The patient reported her dysmenorrhea became severe after the latter surgery. She first underwent a diagnostic hysteroscopy and laparoscopy where she was diagnosed with a unicornuate uterus with a right rudimentary horn. The hysteroscopy was significant for one cervix with passage to one uterine cavity with good visualization of the left ostia, right ostia was not visualized. The diagnostic laparoscopy showed a wide appearing uterus with two definite uterine bodies. The right side appeared to be a redundant fundus with a myoma appearance, the left adnexal structures appeared normal, the right adnexal structures were surgically absent. Chromotubation was performed and the left fallopian tube was patent. Interventions Patient underwent a robotic assisted removal of the uterine rudimentary horn from a unicornuate uterus. The dissection was performed meticulously with care to excise the rudimentary horn without compromise to the right uterine vasculature or the unicornuate cavity. Hysteroscopy was then performed to confirm the integrity of the unicornuate cavity. Conclusion We hypothesize that after removal of the right fallopian tube retrograde menstrual flow was blocked and caused her severe dysmenorrhea. After the excision of the rudimentary horn the patient's pain improved and went on to naturally conceive an intrauterine pregnancy. The Patient is currently in her second trimester.