Study Objective To describe the diagnostic challenge and surgical management of a noncommunicating uterine horn pregnancy. Design Clinical history, brief literature review, and video documentation. Setting Patient was placed in dorsal lithotomy for laparoscopic resection of a uterine horn pregnancy in a tertiary care center. Patients or Participants The patient was a 29 year old G1P0 female presenting with a live 11-week extrauterine pregnancy. Radiologic work-up with both pelvic ultrasound and MRI could not fully ascertain diagnosis. Differential diagnosis included tubal ectopic, horn pregnancy of a bicornuate uterus, interstitial pregnancy, and broad ligament pregnancy. Given this was a wanted pregnancy, intra-sac potassium chloride was not administered pre-operatively and the patient was consented for a diagnostic laparoscopy and possible removal of ectopic pregnancy. Interventions Laparoscopy Measurements and Main Results Diagnostic laparoscopy was undertaken where pelvic inspection revealed a right-sided normal appearing unicornuate uterus and a large left rudimentary noncommunicating horn distended by the pregnancy. The pregnancy was connected to the unicornuate uterus via a thick fibrous band. This confirmed a pregnancy in a Type II-B Mullerian anomaly as per the ASRM classification system. Such pregnancies are rare ranging from 1 in 75,000-150,000. Our video demonstrates a stepwise approach for the excision of such pregnancies including isolation of the ureter retroperitoneally, bladder dissection, use of peritoneal landmarks to ensure safe transection of the fibrous band, and use of hemostatic techniques such as vasopressin and advanced bipolar devices. In addition, we demonstrate a simple technique for oophoropexy where we stabilize a hypermobile ovary to the round ligament pedicle using a laparoscopic ligature device. Conclusion Rudimentary horn pregnancies are rare and pose a diagnostic challenge. Complications are common with >50% of such pregnancies presenting ruptured, thus resection is often recommended. We demonstrate that laparoscopy is a safe and feasible option to manage such pregnancies.