Design: Stepwise demonstration of technique with narrated video footage.

Setting: Unicornuate uteruses are rare Müllerian anomalies with an incidence close to 0.1%. They result from the abnormal development of one of the Müllerian ducts and are associated with a high incidence (40 percent) of renal abnormalities. Here, we demonstrate the removal of a left-sided left sided rudimentary adnexal structure in a patient with a unicornuate uterus. Careful robotic dissection is utilized to ensure complete resection of the Müllerian remnants.

Patients or Participants: A 47-year-old G0 with symptomatic uterine fibroids who desired definitive surgical management. Her history is notable for dextrocardia and a single right-sided kidney with a congenitally absent left kidney. Her left ovary was never identified on ultrasounds.

Interventions: Robotic-assisted removal of the rudimentary adnexal structure at time of hysterectomy: 1) Development of the retroperitoneal space to isolate the adnexal remnant from the surrounding pelvic side wall; 2) Delineation of borders of the adnexal remnant; 3) Isolation and dissection of the infundibulopelvic ligament; 4) Use of bipolar and monopolar energy to secure and transect the remnant.

Measurements and Main Results: Video demonstration of complete resection of rudimentary adnexal remnant.

Conclusion: Careful evaluation and dissection during removal of Mullerian remnants is important in preventing the need for additional interventions and in decreasing the risk of occult malignancies.