Difficult Total Laparoscpoic Hysterectomy (TLH) for a Case with Double Uterus, Double Cervix and Double Vagina, with Severe Pelvic Endometriosis with Diffuse Pelvic Adhesion, with Previous Hemi-Subtotal Hysterectomy

Abstract

Study Objective: Introduction: Total laparoscopic hysterectomy (TLH) for cases with Mullerian anomalies usually possess particular surgical difficulties. Congenital adhesion bands among bladder, rectum, and Mullerian duct may obscure the usual dissection plane. Concomitant deeply infiltrating endometriosis (DIE) will be another problem. For patient with previous incomplete surgical procedures, the situation becomes even worse. (distorted anatomy). Materials & Methods: The 42 y/o lady had Mullerian anomaly. (didelpyis uterus, double cervix, double vagina) She even received open LSO, and Lt subtotal hysterectomy. This time, severe adenomyosis (on Rt uterus), and posterior DIE were noted. Results: Total laparoscopic intervention (TLH+ adhesiolysis + radical excision of DIE lesions) was successfully performed, after complete development of bilateral retroperitoneal spaces, medial pararectal spaces and rectovaginal space. The double vagina lumens were clearly visible through laparoscopic view during the procedure. Conclusion: For patient with Mullerian anomaly associated with advanced endometriosis and severe pelvic adhesion, laparoscopic approach is feasible. Study Objective: Introduction: Total laparoscopic hysterectomy (TLH) for cases with Mullerian anomalies usually possess particular surgical difficulties. Congenital adhesion bands among bladder, rectum, and Mullerian duct may obscure the usual dissection plane. Concomitant deeply infiltrating endometriosis (DIE) will be another problem. For patient with previous incomplete surgical procedures, the situation becomes even worse. (distorted anatomy). Materials & Methods: The 42 y/o lady had Mullerian anomaly. (didelpyis uterus, double cervix, double vagina) She even received open LSO, and Lt subtotal hysterectomy. This time, severe adenomyosis (on Rt uterus), and posterior DIE were noted. Results: Total laparoscopic intervention (TLH+ adhesiolysis + radical excision of DIE lesions) was successfully performed, after complete development of bilateral retroperitoneal spaces, medial pararectal spaces and rectovaginal space. The double vagina lumens were clearly visible through laparoscopic view during the procedure. Conclusion: For patient with Mullerian anomaly associated with advanced endometriosis and severe pelvic adhesion, laparoscopic approach is feasible.