Surgical Management of Rudimentary Horn

INTRODUCTION: Congenital uterine anomalies occur due to the abnormal development of the müllerian ducts during embryogenesis. The prevalence of congenital uterine anomalies is estimated at about 5% in the general population and increased in patients with a history of miscarriage and infertility. Renal anomalies are seen in 30–40% of those with uterine anomalies. This includes duplex collecting system, horseshoe kidney, pelvic kidney, and unilateral renal agenesis. When a renal anomaly is present, it is typically ipsilateral to the congenital anomaly. Unicornuate uterus can occur with and without rudimentary horn, and rudimentary horns can be communicating or non-communicating. The most common type is a non-communicating rudimentary horn. Patients may be asymptomatic or present with cyclic pelvic pain, hematometra, abnormal vaginal bleeding or infertility. Surgical management is typically recommended in those who are symptomatic. OBJECTIVE: The objectives of this video are to discuss the diagnosis and evaluation of rudimentary horn and to discuss the role of surgical management. METHODS: Surgical video highlighting the key steps to surgical management of a rudimentary horn in a 38-year-old patient with left-sided cyclic pelvic pain and infertility. RESULTS: This video demonstrates the key steps for surgical management of a rudimentary horn via a robotic-assisted left hysteroplasty and left salpingectomy. First, the retroperitoneum was opened up to identify and lateralize the ureter. Next, a unilateral salpingectomy was performed. The utero-ovarian ligament was then serially coagulated and cut. The round ligament was divided, and the anterior leaf was dissected to create a bladder flap. The blood supply to the rudimentary horn was identified. The rudimentary horn was then transected and the uterus was closed in a multilayer fashion. Chromopertubation was performed at the beginning and end of the case to assess for tubal patency and to confirm the non-communicating nature of the rudimentary horn. The patient was discharged home on the day of surgery, and her left-sided cyclic pelvic pain completely resolved. CONCLUSIONS: Patients with rudimentary horn can present with variable symptoms, including cyclic pelvic pain due to the proliferative endometrium with obstructed tract. Minimally invasive surgery is a safe and effective option for symptomatic patients.