A Case of Uterine Didelphys with Atypical Peritoneal Anatomy

Study Objective

This video reviews intra-operative considerations for patients with Mullerian anomalies by demonstrating a robotic-assisted laparoscopic hysterectomy for uterine didelphys in a patient with atypical peritoneal anatomy.

Design

Video case presentation.

Setting

Tertiary care center that is a referral center for Minimally Invasive Gynecologic Surgery.

Patients or Participants

This patient is a 20 yo patient with gender dysphoria undergoing laparoscopic hysterectomy for gender affirmation. Pre-operative evaluation is notable for a complete vaginal septum and pelvic MRI shows uterine didelphys.

Interventions

This video outlines a pre-operative approach and checklist for patients with Mullerian anomalies. It then demonstrates robotic-assisted hysterectomy, right salpingo-oophorectomy and left salpingectomy and robotic-assisted vaginal septum take-down. Cystoscopy and bilateral ureteral stent placement was also performed at the beginning of the case. Due to the atypical peritoneal anatomy of the patient, in addition to uterine didelphys, this case is used to review pre-operative planning and intra-operative considerations for patients with Mullerian anomalies undergoing surgery.

Measurements and Primary Results

Not applicable.

Conclusion

In addition to uterine and renal anomalies, patients with Mullerian anomalies may have additional unexpected unique anatomy. Defining patient goals, anticipating distorted anatomy, and planning uterine manipulation and a strategy for tissue extraction are vital for a successful and safe surgery.