Non-communicating rudimentary uterine horn: overview and surgical excision technique

Abstract

To present principles and techniques for safe and efficient laparoscopic excision of a rudimentary non-communicating rudimentary horn. Laparoscopic surgery of a non-communicating rudimentary uterine horn is effective in treating patients with this anomaly. This video will give an overview of a rudimentary uterine horn and review fundamental principles for safe and effective surgical removal of the defect. A 34-year-old female presents with a history of pelvic pain and endometriosis. She was previously diagnosed with a unicornuate uterus with a non-communicating rudimentary horn. The fundamental principles for safe and effective excision of a non-communicating rudimentary horn include: Accurate diagnosis of rudimentary horn via imaging, hysteroscopy, and laparoscopy. Understanding that Mullerian anomalies have a propensity for pelvic pain and endometriosis, therefore a pelvic survey should be completed. Methylene blue can be helpful to surgeons during rudimentary horn excision because it guides surgeons during the surgery and can notify the surgeon when the uterine cavity has been entered. Methylene blue also helps assess the anatomy and functionality of the fallopian tubes during a Mullerian horn resection. Vasopressin should be considered during uterine horn resection to help minimize blood loss. Identifying the location of the uterine vessels in relation to the uterine horn dissection is essential. Preservation of the uterine vessels is optimal, when possible, especially in women who desire future fertility. Reapproximation of anatomy should be attempted to stabilize anatomy and reduce the risk of ovarian torsion. When performing an excision of a rudimentary horn, a surgeon should remember these operative techniques for a safe and efficient procedure. A rudimentary horn is a lateral fusion defect and can be safely excised if one understands the surgical methods.