Remnant Functioning Cervical Tissue After Laparoscopic Removal of Cavitated Noncommunicating Rudimentary Uterine Horn

Robotic-Assisted Laparoscopic Approach to Removal of Müllerian Remnants

BACKGROUND

Robotic-assisted laparoscopy (RAL) is an alternative to traditional laparoscopic surgery that might increase a surgeon's ability to offer minimally invasive removal of Müllerian remnants (MR) to patients with complex anatomy. We report on 2 cases of RAL resection of MR.

CASES

RAL allowed for adequate resection of MR without complications in 2 cases. Case 1 was a 13 year-old female adolescent with VACTERL and uterine remnant close to the ureter of her ipsilateral single kidney. Case 2 was a 16 year-old female adolescent with cloacal exstrophy and omphalocele with remnant hindgut and cervical remnant deep in the pelvis close to the ileal conduit.

SUMMARY AND CONCLUSION

In 2 adolescents with complex anatomy and surgical history, RAL allowed for successful removal of MR.

Laparoscopic metroplasty for unicornuate uterus with a functional noncommunicating rudimentary horn

OBJECTIVE

To evaluate the feasibility of laparoscopic metroplasty for the treatment of unicornuate uterus with a functional noncommunicating rudimentary horn.

METHODS

Laparoscopic metroplasty was performed in one patient using traditional laparoscopy and four patients using robot-assisted laparoscopy from December 2013 to December 2017 at the Obstetrics and Gynecology Hospital of Fudan University. The records of the five patients were analyzed retrospectively.

RESULTS

In all five patients the unicornuate uterus and functional noncommunicating rudimentary horn were unified into a single cavity without intraoperative or postoperative complications. Average operative time was 281 minutes (range, 204-330 minutes) and average blood loss was 180 mL (range, 100-300 mL). Postoperative hospital stay was 7 days (range, 5-11 days) and there was no re-admission. All patients were relieved of pain and had regular menstruation after surgery. Average follow-up time was 44 months (range, 22-70 months). One patient conceived by in vitro fertilization and embryo transfer 2 years after the operation and delivered twins by cesarean at 33 weeks.

CONCLUSION

Laparoscopic metroplasty, with or without robotic assistance, is an acceptable alternative to resection for a noncommunicating rudimentary horn with a functional endometrium.

Surgical management of congenital uterine anomalies (including indications and surgical techniques)

The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3-6.7% in the general population, 3.4%-8% in the infertile population, and 12.6-18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life. To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes. CUA are apparently related to an impaired reproductive outcome, while their exact clinical impact as well as the effectiveness of their treatment remain considered controversial. Surgery is indicated in women presenting with symptoms related to specific uterine anomalies, especially in those with fertility problems. In this review, indications, surgical techniques for the repair of CUA according to their classification, and fertility and pregnancy outcomes before and after surgery will be thoroughly reviewed.