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DOI: 10.1055/s-0029-1241842
© Georg Thieme Verlag KG Stuttgart · New York
Robot-Assisted Laparoscopic Hemihysterectomy for a Rare Genitourinary Malformation with Associated Duplication of the Inferior Vena Cava – A Case Report
Publication History
Publication Date:
16 December 2009 (online)

Introduction
Complex non-communicating Müllerian/Wolffian malformations are rare and a strict classification from an embryological point of view is sometimes difficult [1] [2]. For unknown reasons laterally distributed malformations are more often right-sided [14]. Diagnosis is often delayed due to the rarity of the condition but symptoms typically include increasingly severe dysmenorrhoea. A thorough preoperative investigation is mandatory to rule out other anomalies and to plan a correct surgical approach. Typically, the didelphic uterus is associated with an obstructed hemivagina and almost invariably an ipsilateral renal agenesis [9] [14]. These patients can be successfully treated by resection of the vaginal septum [7] [9]. Alternatively, a unicornuate uterus with a rudimentary horn, which covers a wide range of anatomic variability, requires a hemihysterectomy and sometimes an adnexectomy [8] [9]. These patients are reported to have ipsilateral renal agenesis in 38% of cases [9].
The rationale for a hemihysterectomy in the case of a rudimentary horn is to alleviate dysmenorrhoea, to prevent an intracornual pregnancy and to possibly prevent endometriosis caused by reflux of viable endometrial cells. The rationale for removing the ispilateral fallopian tube is to avoid an ectopic implantation fertilised via the communicating hemiuterus.
We present here a case of left sided non-communicating hemiuterus, a large haemato-oophorosalpinx, ipsilateral renal agenesis and associated inferior vena cava duplication with a high division and aberrant courses of the external iliac and hypogastric veins.
Since October 2005, the Departments of Obstetrics and Gynaecology and Paediatric Surgery at Lund University Hospital have been using the da Vinci system (da Vinci® Surgical System, Intuitive Surgical Inc, CA, USA) to perform robot-assisted surgical interventions. Since then, robot-assisted surgery has been performed on more than 400 patients, providing extensive experience with the system. Using robot-assisted laparoscopy, the grossly enlarged haemato-oophorosalpinx was drained followed by a retroperitoneal dissection and mapping of the aberrant blood vessels, enabling a safe left-sided hemihysterectomy and salpingoophorectomy with minimal blood loss. Written consent to publish the case and associated pictures was obtained from the patient and her parents. We are not aware of any similar reports in the literature.
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Correspondence
Prof. Jan Persson
Department of Obstetrics and Gynaecology
University Hospital and Lund University
22185 Lund
Sweden
Phone: +46 733522080
Fax: +46 46157868
Email: jan.persson@med.lu.se