[Gynecological laparoscopy] 4K laparoscopic rudimentary hysterectomy

A rudimentary horn of the uterus is a congenital malformation of the uterus. It is the result of an abnormality in the fusion process of the paramesonephric ducts during the embryonic period, resulting in incomplete development of the paramesonephric duct on one side. In addition to the normal uterus, there is also a smaller uterus, called the "rudimentary horn", which is mostly not connected to the better-developed uterus on the other side and is only connected by a fibrous band.

How can a rudimentary uterine horn become pregnant?

The sperm travels outside the fallopian tube of the normal uterus to the fallopian tube of the rudimentary uterus and combines with the egg to enter the rudimentary horn. The fertilized egg travels outside the fallopian tube of the normal uterus to the fallopian tube of the rudimentary uterus and enters the rudimentary horn for implantation and development.

Does the rudimentary horn of the uterus need treatment?

Although the rudimentary horn of the uterus has endometrium, it has no function. There is no discomfort and no need for treatment.

The rudimentary horn of the uterus has endometrium and will bleed periodically, but because it is not connected to the normal uterine cavity and the blood cannot be discharged, it will cause dysmenorrhea and even endometriosis, so the rudimentary horn needs to be removed.

In rudimentary horn pregnancy, because the myometrium of the uterus is not well developed, as the fetus continues to grow, the myometrium will rupture completely or incompletely, causing severe intra-abdominal bleeding and endangering the patient's life. The rupture usually occurs between 14 and 20 weeks of pregnancy, and it is rare for the pregnancy to reach full term. Therefore, once a rudimentary horn pregnancy is diagnosed, surgery should be performed as soon as possible to remove the rudimentary horn. If the fetus survives, a cesarean section should be performed first to remove the fetus, and then the rudimentary horn should be removed.

Although rudimentary uterine horn is not common, Li's experience reminds all women of childbearing age:

Pre-pregnancy check-up is very important, which can detect reproductive organ malformations in time;

Abdominal pain in mid-pregnancy is not necessarily a sign of threatened abortion, and should not be blindly treated to preserve the fetus.

Rudimentary horn hysterectomy is one of the common gynecological surgeries. The specific operation process of laparoscopic rudimentary horn hysterectomy is as follows:

Laparoscopic rudimentary horn hysterectomy

1. Perform epidural anesthesia or general anesthesia after routine disinfection.

2. The patient takes the lithotomy position, then routine disinfection and drape.

3. Inflate from the lower abdomen, puncture the cannula and then place the laparoscope.

4. Use laparoscope to explore the pelvic cavity to understand the size, shape, position and relationship of the uterus with surrounding organs.

5. Lift the round ligament on the side of the residual uterine horn with forceps toward the top of the uterus, and cut the round ligament with electrocoagulation.

6. Lift the fallopian tube on the side of the residual uterine horn and use bipolar electrocoagulation forceps to fully electrocoagulate the ligament to close the blood vessels in the ligament and remove the fallopian tube on that side.

7. Wedge-shaped resection of the residual uterine horn, electrocoagulation to stop bleeding, suture the uterine wall with absorbable sutures, and suspend the round ligament on that side of the uterine horn.

8. Rinse the abdominal pelvic cavity, suck out the effusion, remove the hysteroscope and cannula after expelling the gas, and suture the wound.

Case

Patient and measures: The patient was a 12-year-old girl with a rudimentary uterine horn. She had no medical history. She had her first menarche at the age of 11, followed by cyclic left-sided pelvic pain. Ultrasound examination showed a didelphys uterus with fluid retention on the left side. This type of uterine malformation is called an accessory cavitary uterine mass. Progestin therapy was given. MRI examination showed a left-sided non-communicating rudimentary uterine horn with a unicornuate uterus. No other malformations were found, including the kidneys.

First, a colposcopy was performed, and it was found that the vagina had no deformities and only one cervix. Therefore, a 4K ultra-high-definition laparoscopic left rudimentary horn hysterectomy was performed. Compared with the current standard internal and external surgery, minimally invasive surgery is more and more widely accepted by patients and their families because of its less pain, better internal environment stability, more accurate surgical results, shorter hospital stay and better psychological effects.

1. After abdominal distention, a 10mm puncture hole was placed in the umbilicus to place the lens, and three other 5mm puncture holes were made. Abdominal cavity assessment revealed that both appendages including the ovaries were normal.

2. Ligasure was used to remove the left fallopian tube first, close to the fallopian tube to preserve the ovarian blood supply. The remaining fimbria was removed to prevent cancer.

3. The bladder and uterine reflection were opened, separated to the cervix, and the bladder was freed from the residual uterine horn. A hole was made in the broad ligament and pushed outward away from the left ureter. Ligasure was used to sever the left ovarian intrinsic ligament and retain the left ovary, which was supplied with blood by the left pelvic funnel ligament.

4. The left uterine artery was freed, the retroperitoneum was opened, and the left uterine horn was removed with a monopolar electric hook. Slow separation and selective electrocoagulation were performed until the uterine cavity of the residual uterine horn was reached, and old blood was seen flowing out. The entire uterine cavity was removed to confirm that it was not connected to the other uterine cavity.

5. Use 2-0 barbed wire to perform inversion suture to reconstruct the uterus, and finally place an anti-adhesion agent.

Conclusion: Laparoscopic treatment of rudimentary uterine horn is feasible and can achieve satisfactory uterine reconstruction results. This case is not the first report of laparoscopic surgery to treat rudimentary uterine horn. There was a similar case report in 2015, and another video recently described 2 similar cases.

After hysterectomy, you need to follow the doctor's advice, avoid labor, strengthen nutrition, and have regular checkups. The specific matters are as follows:

1. Pay attention to rest and avoid physical labor, especially heavy physical labor, to prevent wound cracking. You can return to the hospital for a follow-up visit one month after surgery, mainly to see the healing of abdominal wounds and vaginal wounds.

2. Within 2 months after surgery, avoid squatting, lifting heavy objects and other actions to prevent increased abdominal pressure and bleeding from vaginal incisions.

3. Do not exercise vigorously within 3 months, and prohibit sexual intercourse to prevent damage to the pelvic floor ligaments.

4. Strengthen nutrition, eat more vegetables and fruits to prevent constipation; eat more high-protein foods to enhance the body's immunity and promote wound healing; at the same time, avoid spicy, irritating and greasy foods.

5. Regularly check color Doppler ultrasound, hormone indicators, etc. after discharge.