Robotic-Assisted Laparoscopic Hemihysterectomy for Recurrent Hemotocolpos/Hematometra in OHVIRA Syndrome

INTRODUCTION: Obstructive hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare condition not commonly described in gynecologic surgery. We present a case of an 18-year-old G0 with history of obstructed right hemivagina and ipsilateral renal agenesis, uterine didelphys, and right renal agenesis. This patient had undergone multiple procedures for resection of obstructed right hemivagina with drainage of hematocolpos and hematometra as well as recurrent failed vaginal cannulization for recurrent right hematocolpos. Given the multiple failed procedures and persistent painful hematocolpos and hematometra, decision was made to procedure with robotic-assisted laparoscopic right hemihysterectomy and salpingectomy. OBJECTIVE: The objective of our study is to describe a novel surgical technique for management of a rare gynecologic condition to improve medical care for patients with OHVIRA. Additionally, to describe concomitant gynecologic pathology that should be considered in management of this condition. METHODS: Single study case report. RESULTS: We performed a robotic-assisted laparoscopic hemihysterectomy and excision of endometriosis. CONCLUSIONS: Hemihysterectomy is an appropriate management option in the setting of recurrent painful hematocolpos/hematometra following failure of less invasive procedures. OHVIRA is a risk factor for endometriosis and close evaluation for endometriosis pathology should be performed intraoperatively. Uterine manipulator use during hemihysterectomy can aid in intraoperative identification of dissection planes and decrease risk of injury to adjacent structures. Utilization of robotic features such as using 4 arms and air seal with smoke evacuator improves dexterity, range of motion, and visualization and enhances patient safety.