Laparoscopic Hemi-Hysterectomy for OHVIRA

INTRODUCTION: Obstructed hemi-vagina and ipsilateral renal anomaly (OHVIRA) is a rare congenital malformation of the female reproductive tract caused by abnormal development of the müllerian ducts. Treatment can include medications to improve symptoms and surgical interventions, including both conservative and definitive approaches. OBJECTIVE: The objectives of this video are to describe OHVIRA, to present a case of OHVIRA, and to demonstrate a surgical technique used for definitive management. METHODS: Educational video demonstrating a novel technique for surgical management of OHVIRA. RESULTS: We demonstrate our approach to a hemi-hysterectomy and hemi-vaginectomy with laparoscopic colpocleisis in an 18-year-old G0P0 patient who failed conservative management and presented with recurrent pelvic pain due to left hematometra, hematosalpinx, and hematocolpos. We highlight the following strategies/techniques that facilitated this complex procedure, including 1) ligation of the internal iliac artery to maintain hemostasis, 2) backfilling the bladder to identify its edges, 3) use of ring forceps in the vagina to delineate its borders, and 4) a novel “laparoscopic colpocleisis” technique allowing permanent closure of the obstructed left hemivagina to prevent disruption of her right hemivagina. The patient recovered well and reported improvement in her pelvic pain. CONCLUSIONS: We have demonstrated the effectiveness of a laparoscopic fertility-sparing surgical approach to treat OHVIRA that prevents disruption of the nonobstructed hemivagina. When conservative treatment fails, surgical management is preferred.