Minimally Invasive Hemi-Hysterectomy for Symptomatic Uterine Didelphys: Surgical Technique and Fertility-Preserving Considerations.

OBJECTIVE: To describe the step-by-step approach to hemi-hysterectomy in a patient with uterine didelphys to reduce pelvic pain while preserving fertility. SETTING: Tertiary academic medical center. PARTICIPANTS: A 32-year-old G0 patient with uterine didelphys, Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome, and chronic pelvic pain. She had previously undergone resection of an oblique vaginal septum for hematocolpos. She presented with persistent pelvic pain requiring multiple emergency room visits, copious white-yellow vaginal discharge and leukocytosis of unknown origin with white blood cell count of 14,000 µL. Exam revealed a hypoplastic left cervix which was thought to be obstructing menstrual flow resulting in chronic pelvic pain. INTERVENTIONS: Robotic-assisted laparoscopic left hemi-hysterectomy and salpingectomy were performed. The left vaginal cuff was closed with special consideration given to the contralateral right cervix, which remained in situ. A medial defect in the right uterus was closed in multiple layers with appropriate reapproximation. Final diagnostic hysteroscopy was performed and confirmed patency and integrity of the remaining uterine cavity. The surgery and postoperative course were uncomplicated. Her chronic pelvic pain, abnormal vaginal discharge, and leukocytosis of unknown origin resolved after treatment. CONCLUSION: Hemi-hysterectomy is not a standard treatment for uterine didelphys-associated pelvic pain but may be considered in highly selected patients with persistent symptoms attributable to one hemiuterus after treatment of associated obstructive anatomy and careful exclusion of alternative etiologies. When pursued, meticulous preoperative planning and surgical technique are essential to preserve the contralateral hemiuterus and its reproductive potential.