7458 Approach to the Fertility-Preserving Surgical Management of a Unicornuate Uterus with a Noncommunicating, Functional Rudimentary Horn

Abstract

<h3>Study Objective</h3> To demonstrate how a unicornuate uterus with a functional non-communicating rudimentary horn in a patient desiring fertility can be safely managed with a robotic approach <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> A tertiary academic hospital <h3>Patients or Participants</h3> A healthy 22-year-old presenting with complaints of cyclic dysmenorrhea and desire for future fertility. <h3>Interventions</h3> A robotic-assisted laparoscopic approach to the resection of a functional non-communicating rudimentary horn with several key strategies to minimize blood loss, damage of normal tissue, and prevention of adhesion formation. 1. Placing a stay suture through the tissue of the rudimentary horn to aid with traction and counter traction necessary for enucleation of the horn in the correct tissue cleavage plane. 2. Minimizing blood loss by dilute vasopressin injection at planned incision site along with care to stay within the fibrotic tissue layer connecting the rudimentary horn to the unicornuate uterus. 3. Removing canalized fallopian tube attached to rudimentary horn to prevent rudimentary horn pregnancy. 4. Combination cold dissection with careful and deliberate use of electrosurgery following principles to minimize thermal injury to surrounding normal myometrium. 5. Two-layer non-locking suture to restore tissue integrity, ensure hemostasis, and prevent adhesion formation. 6. Surgical treatment (excision preferred) of all endometriosis at the time of surgery. <h3>Measurements and Main Results</h3> Final pathology confirmed a rudimentary horn with functioning endometrial tissue, endometriosis implants, and endometriosis of the appendix. <h3>Conclusion</h3> This technique allows for the surgical removal of a non-communicating rudimentary horn with: Restoration of anatomy, prevention of rudimentary horn pregnancy, removal of endometriosis, and optimization of future fertility.