Approach to the Total Laparoscopic Hysterectomy for a Didelphys Uterus

372 Views | Sep 26, 2019

Authors: Brenna Swift, Arthur Zaltz, Carmen McCaffrey

Affliations: University of Toronto

Didelphys uterus occurs with incomplete fusion of the Mullerian ducts, generating two uterine cavities, two cervices and a longitudinal vaginal septum. The incidence of Mullerian anomalies is 0.5-5% in the general population with didelphys uterus representing 8.3% of all Mullerian anomalies.Our surgical case is a 41 year old G2P2 female with Lynch syndrome. Upon completion of childbearing, she elected to undergo a risk-reducing hysterectomy and bilateral salpingo-oophorectomy. She had a known didelphys uterus and had 2 previous cesarean sections. An approach to a total laparoscopic hysterectomy for didelphys uterus is not widely described in literature. This video highlights surgical techniques to overcome unique challenges associated with a didelphys uterus. We demonstrate identification of renal anomalies associated with didelphys uterus, ligation of the uterine artery at the origin and techniques for dissection of the bladder flap after two previous cesarean sections to facilitate a wider colpotomy.