Uterine Horn Research Articles

Computed tomography can differentiate vaginal-origin from uterine-origin lesions in bitches.

To investigate typical computed tomography (CT) features for the differentiation of vaginal from the uterine origin in dogs. 7 healthy Beagles in the prospective study and 5 bitches in the retrospective study. In the prospective study, dual-phase CT images were obtained from sexually intact female Beagles (n = 7) during anestrus and estrus. On the CT images, the vagina and uterine horns, body, and cervix were assessed for diameter, attenuation, and contrast enhancement pattern. In the retrospective study, CT features of large vaginal lesions (leiomyoma, leiomyosarcoma, adenocarcinoma, hematocolpos, and Gartner's duct cyst) were assessed in 5 bitches. In normal bitches, the cervix was thicker with strong central enhancement compared to the uterus and vagina. The uterine artery, which enters the mesometrium at the level of the cervix, was clearly visualized and assisted in identifying the cervix. In bitches with large vaginal masses, uterine arteries were displaced by the lesions and could not be used to locate the cervix. In 4/5 dogs with vaginal masses, identification of the cervix allowed the determination of the organ of origin. In 1 dog with adenocarcinoma, CT vaginography was additionally required for determining the origin of mass. Results from this study indicate that the cervix, recognized in CT as focal thickening of the uterus with central enhancement, may be used as a landmark for the differentiation between the uterus and vagina in bitches.

Unusual Torsion of Hematosalpinx in a Case of MRKH Syndrome

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly of the female reproductive tract characterized by the absence of the upper two thirds of the vagina and the uterine cervix, and hypoplasia or complete aplasia of the uterus [1]. Typically, patients with MRKH syndrome present with primary amenorrhea while exhibiting normal secondary sexual characteristics and a normal female karyotype (46, XX) [2]. In fewer cases, they suffer from cyclic pelvic pain due to active endometrium in the hypoplastic uterine horns [3].

Evidence for Involvement of GIP and GLP-1 Receptors and the Gut-Gonadal Axis in Regulating Female Reproductive Function in Mice.

Substantial evidence suggests crosstalk between reproductive and gut-axis but mechanisms linking metabolism and reproduction are still unclear. The present study evaluated the possible role of glucose-dependent-insulinotropic-polypeptide (GIP) and glucagon-like-peptide-1 (GLP-1) in reproductive function by examining receptor distribution and the effects of global GIPR and GLP-1R deletion on estrous cycling and reproductive outcomes in mice. GIPR and GLP-1R gene expression were readily detected by PCR in female reproductive tissues including pituitary, ovaries and uterine horn. Protein expression was confirmed with histological visualisation of incretin receptors using GIPR-Cre and GLP1R-Cre mice in which the incretin receptor expressing cells were fluorescently tagged. Functional studies revealed that female GIPR-/- and GLP-1R-/- null mice exhibited significantly (p < 0.05 and p < 0.01) deranged estrous cycling compared to wild-type controls, indicative of reduced fertility. Furthermore, only 50% and 16% of female GIPR-/- and GLP-1R-/- mice, respectively produced litters with wild-type males across three breeding cycles. Consistent with a physiological role of incretin receptors in pregnancy outcome, litter size was significantly (p < 0.001-p < 0.05) decreased in GIPR-/- and GLP-1R-/- mice. Treatment with oral metformin (300 mg/kg body-weight), an agent used clinically for treatment of PCOS, for a further two breeding periods showed no amelioration of pregnancy outcome except that litter size in the GIPR-/- group was approximately 2 times greater in the second breeding cycle. These data highlight the significance of incretin receptors in modulation of female reproductive function which may provide future targets for pharmacological intervention in reproductive disorders.

Ectopic Pregnancy: An Overview

Objectives: Purpose of this narrative review is to compare, the latest findings about ectopic pregnancy (EP) reporting pathogenetic hypothesis, common and uncommon symptoms, diagnostic work-up, treatment alternatives. EP is a pathological condition characterized by an abnormal blastocyst implant at any site apart from uterine cavity. Dealing with pathogenesis we can recognize many factors: hormonal imbalance, post infective or mechanical induced defects of the tube, assisted reproduction techniques. This condition has aroused interest for its capacity to evolve instantly in a life-threatening condition, needing an early diagnosis and an urgent surgical solution. Mechanism: A comprehensive literature research of recent articles has been performed. Researches for relevant data were conducted utilizing multiple databases, including PubMed, SCOPUS and Ovid. Searches included combinations of the key terms: tubal pregnancy, cervical pregnancy, cesarean scar pregnancy, ‘twin and ectopic pregnancy’, ‘twin and tubal pregnancy’, ‘twin heterotopic pregnancy’, ‘laparoscopy and twin pregnancy’, ‘laparoscopy and tubal pregnancy’, ‘surgery and pregnancy’, ‘surgery and ectopic’, ‘surgery and twin tubal pregnancy’, “methotrexate and twin pregnancy ‘cornual pregnancy’ ”. Findings in brief: EP is frequently located in the salpinges but may also occur in many other sites like uterine horns, cervix, ovaries, cesarean scar or in splanchnic organs. Typical signs and symptoms of EP usually consist of pelvic pain, vaginal bleeding or sudden amenorrhea. Beta-human chorionic gonadotropin (b-hCG) dosages are fundamental tools for diagnosis of the early pregnancy whether is normal or not, always considering tubal pregnancy a possible event. Imaging diagnostic tools are described in our review, Ultrasound, Magnetic resonance imaging (MRI), Computed Tomography (CT) are the main options. When the serum b-hCG is positive but at ultrasound examination of pregnancy cannot be found, physician must define this condition as a pregnancy of unknown location (PUL). In this literature-based review we found three therapeutic solutions: expectant, medical or surgical management. Expectant strategy consists of strictly monitoring b-hCG values with no pharmacological or surgical intervention. Methotrexate administration following therapeutic schemes is a cost-effective solution and keeps patient away from surgical risks. Surgery maintains a key role in treatment choice considering that is the only one available in emergency scenario. Conclusions: EP is a diagnostic challenge for the physician, therapy choice is a careful and difficult decision that must be always individualized to ensure patient life uppermost and also future fertility desire.

The Effect of Aluminum Exposure on Maternal Health and Fetal Growth in Rats.

Background This study was performed on female rats to study the effect of oral administration of low dose versus high dose of aluminum chloride (AlCl3) during the period of organogenesis on the maternal and fetal growth parameters. Methods In this study, female mature nulliparous Sprague-Dawley albino rats were used. After mating and confirmation of pregnancy, successfully mated females were divided into threegroups (six rats each): control group, low-dose (LD) AlCl3 group, and high-dose (HD) AlCl3 group. The rats were sacrificed at gestational day 20 (GD20) when the liver and kidneys were excised and weighed. Also, the gravid uterine horns were excised and weighed, the placentae and fetuses were extracted and weighed, and fetal growth parameters were assessed. Results Maternal AlCl3 exposure produced an increase in preimplantation losses and resorptions in LD and HD AlCl3 groups. Consequently, there was a decrease in the number of corpora lutea, total implantations, live fetuses, and litter size. Also, the body weight gain, gravid uterine, placental and maternal liver, and maternal kidney weights of bothAlCl3-treated groups were significantly reduced in comparison with the control group. There was a statistically significant reduction in fetal biparietal diameter (BPD), head length (HL), crown-rump length (CRL), and fetal body weight. All the above changes were dose-dependent, being more evident with the high dose of AlCl3. Conclusion AlCl3 exposure during pregnancy results in different degrees of adverse effects on maternal weight gainand fetal growth and organ parameters, which followed a dose-dependent manner.

Reproductive Outcome of the Patients with Uterus Unicornis: Five Year Experience in a Tertiary Center.

The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center. Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited into this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period. Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Twelve (85.7%) patients had a live birth (71.4% term delivery, 21.4% preterm delivery), and two (15.3%) had a first-trimester spontaneous abortion. Six (50%) of 12 patients who had a live birth received tocolytics for preterm labor. Unicorn uterus is a rare anomaly diagnosed mostly during infertility work-up and might be related to the poor obstetric outcome, but early diagnosis is important for successful pregnancy results for preterm delivery especially in the secondary infertile group. In addition, rudimentary horn excision is recommended due to the high risk of obstetric complications.

Sex bias in utero alters ovarian reserve but not uterine capacity in female offspring†.

Environmental stressors to which a fetus is exposed affect a range of physiological functions in postnatal offspring. We aimed to determine the in utero effect of steroid hormones on the reproductive potential of female offspring using a porcine model. Reproductive tracts of pigs from female-biased (>65% female, n = 15), non-biased (45-54.9% female, n = 15), and male-biased litters (<35% females, n = 9) were collected at slaughter (95-115kg). Ovaries and uterine horns were processed for H&E or immunohistochemistry. Variability of data within groups was analyzed with a Levene's test, while data were analyzed using mixed linear models in R. In the ovarian reserve, there was a significant birth weight by sex ratio interaction (P = 0.015), with low birth weight pigs from male-biased litters having higher numbers of primordial follicles with opposite trends seen in pigs from female-biased litters. Sex bias held no effect on endometrial gland development. A lower birth weight decreased the proportion of glands found in the endometrium (P = 0.045) and was more variable in both male-biased and female-biased litters (P = 0.026). The variability of primordial follicles from male-biased litters was greater than non- and female-biased litters (P = 0.014). Similarly, endometrial stromal nuclei had a greater range in male- and female-biased litters than non-biased litters (P = 0.028). A crucial finding was the greater variability in primordial follicles in the ovaries from females derived from male-biased litters and stromal cell count in the endometrium of females from male- and female-biased litters. This could be inflating the variability of reproductive success seen in females from male-biased litters.

Exposure to Low Zearalenone Doses and Changes in the Homeostasis and Concentrations of Endogenous Hormones in Selected Steroid-Sensitive Tissues in Pre-Pubertal Gilts.

This study was undertaken to analyze whether prolonged exposure to low-dose zearalenone (ZEN) mycotoxicosis affects the concentrations of ZEN, α-zearalenol (α-ZEL), and β-zearalenol (β-ZEL) in selected reproductive system tissues (ovaries, uterine horn-ovarian and uterine sections, and the middle part of the cervix), the hypothalamus, and pituitary gland, or the concentrations of selected steroid hormones in pre-pubertal gilts. For 42 days, gilts were administered per os different ZEN doses (MABEL dose [5 µg/kg BW], the highest NOAEL dose [10 µg/kg BW], and the lowest LOAEL dose [15 µg/kg BW]). Tissue samples were collected on days seven, twenty-one, and forty-two of exposure to ZEN (exposure days D1, D2, and D3, respectively). Blood for the analyses of estradiol and progesterone concentrations was collected in vivo on six dates at seven-day intervals (on analytical dates D1-D6). The analyses revealed that both ZEN and its metabolites were accumulated in the examined tissues. On successive analytical dates, the rate of mycotoxin accumulation in the studied tissues decreased gradually by 50% and proportionally to the administered ZEN dose. A hierarchical visualization revealed that values of the carry-over factor (CF) were highest on exposure day D2. In most groups and on most exposure days, the highest CF values were found in the middle part of the cervix, followed by the ovaries, both sections of the uterine horn, and the hypothalamus. These results suggest that ZEN, α-ZEL, and β-ZEL were deposited in all analyzed tissues despite exposure to very low ZEN doses. The presence of these undesirable compounds in the examined tissues can inhibit the somatic development of the reproductive system and compromise neuroendocrine coordination of reproductive competence in pre-pubertal gilts.

Evaluation of Maternal Toxicity in Rats Exposed to the Total Extract of the Alkaloids in the seeds of Peganum harmala L. during Pregnancy

Peganum harmala L. (Zygophyllaceae) known locally as harmel is a medicinal plant. In traditional medicine, its seeds have long been used for therapeutic purposes because of their richness in β-carboline alkaloids. This study aimed to evaluate the maternal and developmental toxicity during pregnancy by daily IP administration of 7.99 mg/kg/day (1/20 DL50) of total alkaloids extract in P.harmala’ seeds. The results summarized in confirmed pregnancy rates were high 90-100%, decreased locomotor activity, paralysis, and hypothermia. Maternal body weight and weight gain changes were statistically significant in all pregnant. Precisely, the relative weight of ovaries was significantly changed in all the groups treated. The ALAT and gamma GT concentrations show a significant change in the group treated for seven days. Significant changes in the total and indirect bilirubin levels were observed in all treated groups. The hormonal analysis showed a significant decrease in FSH levels in a treated group for seven days and two weeks, Progesterone levels were increased significantly in treated groups for seven and three weeks and increased significantly in a treated group for two groups, however, the levels of Estrogen were changed significantly only in the treated group for three. The results show a significant difference in total resorbed litters and the number of fetus deaths in the group treated for three weeks. The fetus weight in the group treated for two weeks was significant. The results show a significant decrease in the number of implantations and an increase in pre-and post-implantation loss rates, and there were no developed live or dead, and no resorbed fetuses in all treated dams, there were only implantation sites in both uterine horns. The total extract of the alkaloids in the seeds of P. harmala has adverse effects on maternotoxicity, embryonic development, and abortion.

Effects of intrauterine human chorionic gonadotropin administration on endometrial receptivity and embryo implantation

AimsEven though major advances have occurred in in vitro fertilization-embryo transfer (IVF-ET) techniques in recent years, low efficacy of embryo implantation rates after fresh cycle of IVF-ET around 25–30 % is still a biggest challenge to physicians. To address this, clinicians have used intrauterine administration of human chorionic gonadotropin (hCG), one of the initial arrays of molecular crosstalk occurred at maternal-fetal interface. However, many reports have demonstrated the conflicting outcomes with various efficacy. This study aims to provide evidence of the optimal timing of hCG administration to enhance the rates of embryo implantation via improving the uterine environment. Main methodshCG was administered into one side of mouse uterine horns and saline was infused into the other side of horns as a control. Alterations in the endometrial thickness, endometrial receptivity and angiogenesis-related gene expression, responses of progesterone receptor, and subsequent in vitro fertility assessment were evaluated in hCG-treated endometrium in mice. Key findingshCG administration induced a serial induction of endometrial receptivity and angiogenesis-related genes and maximally enhanced their expression levels around 72 h after treatment with no significant morphological alterations in the numbers of endometrial glands and thickness. Moreover, using an in vitro model of embryo attachment, hCG treatment significantly promoted the stability of attached embryos, supporting the positive effect of hCG on the initial stage of embryo implantation. SignificanceOur findings suggest a new consensus criteria providing a potential strategy of clinical use of hCG for the cleavage-stage ET rather than blastocyst-stage ET to achieve maximal effects of IVF-ET.

Doppler Velocimetry of Uterine Artery in Bitches with Cystic Endometrial Hyperplasia-Pyometra Complex

Doppler ultrasound is a useful diagnostic tool to evaluate uterine blood flow in different canine reproductive states. The aim of this study was to describe and compare uterine blood flow in bitches suffering from pyometra according to the ultrasonographic appearance of uterus. Seventy-five bitches with pyometra confirmed clinically, haematologically and ultrasonographically were included in the study. Ten healthy bitches with no haematological and ultrasonographic abnormality of uterus were also included in the study as control group. The bitches with pyometra were divided into four groups based on the sonographic characterization of uterus and its luminal contents, viz., B (few small cysts, normal endometrial surface, anechoic uterine content, n=11), C (many large cysts, irregular surface and hypertrophic endometrium, n=24), DH (many large cysts, irregular surface and hypertrophic endometrium, hyperechoic content, n=31) and DA (many large cysts, irregular surface and atrophic endometrium, hyperechoic content, n=9). The uterine horn diameter and uterine wall thickness was measured with two-dimensional ultrasonography. With the use of pulsed-wave Doppler, flow velocity waveforms of uterine artery were obtained. Parameters of blood flow velocity such as peak systolic velocity (PSV), end diastolic velocity (EDV), as well as haemodynamic parameters such as resistance index (RI), pulsatility index (PI) and systolic-diastolic ratio (S/D) were calculated electronically. Peak systolic velocity and end diastolic velocity were significantly higher in pyometra group than control with highest velocities recorded in DA group (P&lt;0.05). The RI, PI and S/D were significantly lower in pyometra group than in control (P&lt;0.05). The RI was significantly lower in group C and DA compared to groups B and DH (P&lt;0.05). However, no significant difference was reported in PI and S/D among the groups of pyometra (P&gt;0.05). It was concluded that the uterine artery blood flow velocity of bitches suffering from pyometra differs, not only from normal bitches, but also varies with the type of pyometra with varying pathological nature. Furthermore, haemodynamic parameters appear as useful markers to differentiate uterine pathologic conditions and to understand the pathological type of pyometra.

Robotic Fallopian Tubo-Uterine Implantation

<h3>Study Objective</h3> The objective of this video is to demonstrate the robotic and hysteroscopic surgical technique for implanting the distal fallopian tube to the proximal uterine cornua in a patient with bilateral fallopian tubal occlusion. This is an alternative option to surgically manage infertility other than via in vitro fertilization. <h3>Design</h3> Surgical video recording of hysteroscopic and robotic steps to implant the fallopian tube to the uterine cornua, with fallopian tube patency confirmation. <h3>Setting</h3> Operating Room. <h3>Patients or Participants</h3> 33-year-old G0 female with bilateral proximal fallopian tube occlusion and suspected endometriosis. She declined in vitro fertilization and desired surgical management. <h3>Interventions</h3> Robotic fallopian tube implantation at the uterine cornua using hysteroscopic assistance and chromopertubation confirming tubal patency. <h3>Measurements and Main Results</h3> Fallopian tube anastomosis is an option for patients who desire a surgical option to help achieve fertility with tubal factor infertility. This technique can achieve up to 80% success rate in pregnancy. With appropriate counseling, patients should be given this option when discussing tubal factor infertility. <h3>Conclusion</h3> Fallopian tube anastomosis can be a more cost-effective option than in vitro fertilization if a patient only has tubal factor infertility or does not desire to undergo assisted reproductive technologies with IVF. This approach is efficient and effective to treat tubal factor infertility and patency of the tube is confirmed during the procedure. Patients can begin trying for pregnancy shortly after their first post operative visit.

Minimally Invasive Management of a Second Trimester Miscarriage in a Patient with a Non-Communicating Uterine Horn

<h3>Study Objective</h3> We present a rare case of an 18-week missed abortion in a patient with a previously undiagnosed non-communicating uterine horn. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A patient with a history of suspected bicornuate uterus presented with missed abortion at 18 weeks gestation. <h3>Interventions</h3> Prior attempt at dilation and evacuation was unsuccessful and a diagnostic hysteroscopy confirmed no connection between the uterine cavity and the pregnancy. MRI imaging confirmed a unicornuate uterus with a non-communicating horn. Exploratory laparoscopy with hemi-hysterectomy and removal of uterine horn with fetus was performed. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Timely diagnosis of pregnancy within an unruptured non-communicating horn is exceedingly rare. With adequate workup including proper imaging, surgical planning, and technical expertise, safe laparoscopic removal of both the rudimentary horn and fetus is possible and should be offered to spare the patient the morbidity of laparotomy.

Laparoscopic Resection of Rudimentary Horn for Treatment of Pelvic Pain

<h3>Study Objective</h3> To provide a brief overview of symptomatology of rudimentary uterine horns, as well as to demonstrate a minimally invasive resection of a rudimentary horn for treatment of pelvic pain. <h3>Design</h3> Surgical video. <h3>Setting</h3> Academic tertiary care hospital. <h3>Patients or Participants</h3> 24-year-old G0P0 initially evaluated for worsening menorrhagia and dysmenorrhea. Pelvic MRI showed a unicornuate uterus with a 2.5 cm nondistended noncommunicating right rudimentary horn. <h3>Interventions</h3> A laparoscopic resection of a rudimentary uterine horn was planned. The right pelvic sidewall was opened. The origin of the uterine artery was dissected out and cauterized. The round ligament was divided, and the anterior leaf of the broad ligament was undermined and incised to the end of the rudimentary horn. The right fallopian tube was followed to its fimbriated end, and a total salpingectomy was performed, and the remaining portion of the rudimentary horn was resected. A posterior colpotomy was created, and a specimen retrieval bag was inserted through the colpotomy. The specimen was completely removed in the bag. The colpotomy was then closed in a running fashion. <h3>Measurements and Main Results</h3> The patient was discharged on post operative day zero. She had a follow-up visit after 1 week, meeting all milestones and without complications. Upon long term follow up she reported improved pain. <h3>Conclusion</h3> Uterine rudimentary horns represent a mullerian anomaly that can be associated with cyclic pelvic pain. Laparoscopic resection of rudimentary horn can offer a minimally invasive option for immediate improvement in pelvic pain.

Fertility-Sparing Cornual Wedge Resection for Management of GTN

<h3>Study Objective</h3> To describe the case of a 30-year-old female with cornual ectopic pregnancy treated with methotrexate with normalization of beta-hCG who subsequently developed GTN at the prior ectopic site. The patient desired future fertility and was treated with actinomycin-D with optimal response and negative beta-hCG for four months, yet the mass was persistent. The patient desired future fertility, and with guidance from gynecologic oncology and reproductive endocrinology, decision was made to proceed with a conservative operation. We demonstrate the technique of cornual wedge resection for treatment of GTN. <h3>Design</h3> Case-report <h3>Setting</h3> The patient was placed in dorsal lithotomy position with lower extremities in Allen-type stirrups and was placed in steep Trendelenburg position. <h3>Patients or Participants</h3> N/A - single patient, case report <h3>Interventions</h3> Actinomycin-D administered until beta-hCG negative for 4 months, mass noted to be persistent at uterine cornu, laparoscopic cornual wedge resection for removal of GTN given patient's desire to maintain future fertility <h3>Measurements and Main Results</h3> Pathology of the mass demonstrated necrotic chorionic villi and placental remnants, negative for malignancy. Follow up transvaginal ultrasound 3 months postoperatively demonstrated no residual mass and no uterine defect. Checking beta-hCG monthly until 12 months with negative tests, then will attempt to conceive with support from reproductive endocrinology and planned cesarean delivery similar to the management of patient's post-myomectomy. <h3>Conclusion</h3> With subspecialty support from gynecologic oncology and reproductive endocrinology, cornual wedge resection should be considered a viable option for treatment of GTN in patients who desire future fertility.

8809 Laparoscopic Cornual Resection after Ectopic Pregnancy in Fallopian tube Remnant

<h3>Study Objective</h3> To review ectopic pregnancies after salpingectomies. To demonstrate a safe and feasible approach to a laparoscopic cornual resection after an ectopic in a fallopian tube remnant. <h3>Design</h3> A single person case report with a stepwise demonstration of surgical techniques with narrated video footage. <h3>Setting</h3> Tertiary-care academic center. <h3>Patients or Participants</h3> A 31-year-old has a history a history of a right salpingo-oophorectomy in childhood and a left salpingectomy after a history of two ectopic pregnancies. She presented with a right fallopian tube remnant ectopic pregnancy, which was treated with methotrexate. Prior to embryo transfer, it was recommended for her to have this right tubal remnant removed. <h3>Interventions</h3> Vasopressin was administered into the uterus for bleeding prevention into the right cornua. A uterine manipulator was placed, and methylene blue was injected to delineate the tubal ostia and thus the area of resection. A small wedge resection of the cornua was performed and the uterus closed in 2 layers with a 2-0 V-loc suture. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Ectopic pregnancies after bilateral salpingectomies are rare. In patients who desired invitro fertilization after a history of an ectopic pregnancy in a fallopian tube remnant, may safely undergo a resection of the uterine cornua, by a trained gynecologic surgeon.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

8972 Laparoscopic Rudimentary Horn Removal

<h3>Study Objective</h3> To demonstrate key steps to laparoscopic resection of a rudimentary horn. <h3>Design</h3> A case report. <h3>Setting</h3> A tertiary care teaching hospital. <h3>Patients or Participants</h3> The case is based on a 14-year-old, gravida zero, with a non-communicating rudimentary horn and unicornuate uterus. <h3>Interventions</h3> The video demonstrates pre-operative imaging, highlights key anatomy, and teaches techniques to laparoscopic resection of the horn with oversewing of the defect. <h3>Measurements and Main Results</h3> Safe and efficient laparoscopic non-communicating uterine horn removal. <h3>Conclusion</h3> Laparoscopic uterine horn removal can be a safe and efficient outpatient procedure.

8356 Robotic Surgery: Pelvic Mass Excision, Resection of Non-Communicating Uterine Horn, and Fulguration of Endometriosis

<h3>Study Objective</h3> To demonstrate surgical techniques for approaching an advanced case of endometriosis in a patient with a congenital uterine anomaly, large pelvic mass, and severe adhesive disease. <h3>Design</h3> A step-by-step explanation of the surgery. <h3>Setting</h3> Community Based Teaching Hospital, Operating Room. <h3>Patients or Participants</h3> 33-yo G0 with known unicornuate uterus with non-communicating uterine horn, dysmenorrhea, suspected endometriosis, infertility, congenital absence of right kidney. <h3>Interventions</h3> Chromotubation was first performed to evaluate if the patient had patent fallopian tubes. The pelvic mass was then decompressed and drained revealing multiple right ovarian cysts. Anatomical landmarks were identified with a retroperitoneal dissection and extensive lysis of adhesions. The bladder was backfilled intermittently to help identify surgical planes. A Keith needle was temporarily placed in the abdomen to elevate the pelvic mass and aid in visualization. The pelvic mass and non-communicating uterine horn were resected. Hemostasis was achieved with electrocautery and suturing. Endometriotic implants in the pelvis and diaphragm were fulgurated and an appendectomy was performed due to extensive damage from endometriosis. All specimens were placed in a bag and removed through the umbilical port site. Post-operatively, the patient was started on progesterone therapy. <h3>Measurements and Main Results</h3> Successful completion of surgery, no complications, the patient reported improvement in her symptoms. <h3>Conclusion</h3> When dealing with severe adhesive disease, abnormal anatomy, and limited space due to a pelvic mass it is key to approach these cases in a stepwise fashion. Visualization can be optimized via temporary measures such as using a Keith needle. If irregular anatomy is noted, landmarks can be identified via the retroperitoneal dissection.

GnRH administration after estrus induction protocol decreases the pregnancy rate of recipient ewes following transfer of frozen-thawed embryos

The objective of this study was to investigate the effects of GnRH on the pregnancy rate and the embryo survival rate of recipient ewes following embryo transfer. Estrus was synchronized in 83 nulliparous Huyang ewes using intravaginal sponges impregnated with 45 mg flurogestone acetate. The sponge was left in the vagina for 12 days followed with an injection of 330 IU of eCG at sponge removal. The treatment group (n = 34) was subjected 48 h after sponge removal to intramuscular administration with 16 μg of the GnRH agonist triptorelin and the control group (n = 49) with 1 mL of saline solution. Embryo transfer was performed by laparoscopy on day 8 after sponge removal, which transferred frozen-thawed embryos of Suffolk ewes directly to the anterior third of the corpus luteum ipsilateral uterine horn of the recipient ewe.Each recipient with at least one normal corpus luteum received one grade I embryo. The proportion of ewes with at least one normal corpus luteum in the control group was significantly lower compared to the treatment group (73.5 % vs 91.2 %, P < 0.05). In total, 62 embryos were transferred into 62 ewes and 29 lambs were born. The pregnancy rate (59.4 % vs 33.3 %, P < 0.05) and the embryo survival rate (56.3 % vs 30.0 %, P < 0.05) in the control group were significantly higher compared to the treatment group. In conclusion, a single dose of GnRH administered 48 h after sponge removal significantly decreased the pregnancy rate and the embryo survival rate of recipient ewes following transfer of frozen-thawed embryos.