Triple Precision: Laparoscopic Excision of ACUM, Salpingectomy & Ovariotomy – Stepwise Surgical Video
Case description
Case: 32-year-old unmarried female with chronic pelvic pain, known psychiatric illness, and no fertility desires. Imaging showed a hemi-uterus (U4a) with a non-communicating rudimentary horn (ACUM), right hydrosalpinx, and left ovarian torsion.
Surgical procedure:
Laparoscopic right salpingectomy, left ovariotomy, and excision of the ACUM.
Key steps:
Detailed pelvic inspection revealing distorted anatomy
Right salpingectomy with careful preservation of surrounding structures
Left ovariotomy for non-viable torsioned endometriotic ovary
Vasopressin-assisted dissection and enucleation of ACUM after bladder mobilization
Layered closure ensuring hemostasis
Uniqueness:
Rare Müllerian anomaly (U4a) with ACUM
Surgical management tailored to preserve uterine function despite bilateral adnexal loss
Complete excision of non-communicating horn to prevent future pain and endometriosis
Technically challenging due to high bladder and dense adhesions.
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