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Laparoscopic metroplasty: reconstructive surgery for unicornuate uterus with noncommunicating, functional uterine horn.

Abstract：

OBJECTIVE:To demonstrate laparoscopic surgery for a patient with unicornuate uterus and a large hematometra in the noncommunicating uterine horn. DESIGN:Narrated video featuring the diagnostic tests and surgical management. SETTING:Academic tertiary hospital. PATIENT(S):A 13-year-old woman, gravida 0 with menarche at 9 years old, had severe dysmenorrhea during her recent menstrual cycles. The results of transrectal three-dimensional sonography, hysteroscopy, and magnetic resonance imaging (MRI) were consistent for a uterine didelphys composed of a right unicornuate uterus and a left hemiuterus with hematometra and no connection to the cervix. Left adnexal endometrioma and ipsilateral renal agenesis were also noted. INTERVENTION(S):Laparoscopic adhesiolysis and enucleation of the left ovarian endometrioma were first performed. Then, implementing the concepts of Strassman unification method, a horizontal incision was made on the medial side of each hemicorpus, starting from the left rudimentary horn and ending at the fundal area of the right hemiuterus. The incision was carried deep enough to reach the endometrium. The opposing, reverted myometrium was then reapproximated from the lower end of the uterus to the upper fundal part in two layers, using absorbable bidirectional monofilament barbed suture. The outer serosal layer was closed with 1-0 Monocryl via a running continuous suture. On postoperative day 2, the patient was discharged uneventfully. MAIN OUTCOME MEASURE(S):Symptomatic relief and restoration of normal and functional anatomy. RESULT(S):The patient has regular menstrual cycles with no recurrence of dysmenorrhea or ovarian endometrioma. At a 2-year postoperative follow-up evaluation, hysteroscopic examination revealed a single uterine cavity with a small fundal septum. The MRI scans showed an anteverted, symmetrical uterus. CONCLUSION(S):In comparison with the widely applied hemihysterectomy, reconstructive laparoscopic metroplasty not only effectively achieves symptomatic relief but also offers better uterine symmetry and a larger intrauterine cavity via unification of the uterus.

journal_name

Fertil Steril

journal_title

Fertility and sterility

authors

Yen CF,Hsin-Yu Pai A,Lo A,Chueh HY,Huang HY,Lin SL

doi

10.1016/j.fertnstert.2020.05.042

subject

Has Abstract

pub_date

2020-11-01 00:00:00

pages

1119-1121

issue

5

eissn

0015-0282

issn

1556-5653

pii

S0015-0282(20)30533-1

journal_volume

114

pub_type

杂志文章

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