Fertility-Preserving Robotic Assisted Management of OHVIRA Syndrome (Obstructed Hemi-Vagina)

Study Objective

To describe robotic-assisted surgical management in a patient with OHVIRA syndrome (obstructed hemi-vagina).

Design

This is a video submission describing the surgical steps. The patient was followed for 3 months.

Setting

The patient underwent robotic-assisted surgery under general anesthesia in the dorsal lithotomy position.

Patients or Participants

29 YO G0 was referred for infertility, pelvic pain, and irregular menstrual cycles.

Interventions

Preoperative MRI imaging revealed a didelphys uterus, an obstructed left hemi-vagina, and left renal agenesis. The patient had a surgical history significant for rectal surgery as a newborn and a history of laparoscopy indicating adhesions and endometriosis. A decision was made to proceed with robotic-assisted hemivaginal septum excision due to the surgical complexity.

Measurements and Primary Results

A robotic-assisted approach allowed for complete drainage of the hematocolpos via a posterior colpotomy, as well as excision of a 4 cm disc of the vaginal septum.

Conclusion

This surgical video outlines the steps required to excise a vaginal septum for an obstructed hemi-vagina using robotic assistance under direct visualization.