Design: Surgical video of a minimally invasive approach in management of patients with Mullerian anomalies in Advocate Lutheran General Hospital. Patients were either referred from their primary OBGYN with suspicion for Mullerian anomaly, or presented acutely to the hospital and the minimally invasive gynecologic surgery service was consulted for management following Mullerian anomaly diagnosis with imaging.

Setting:

• Private practice of minimally invasive gynecologist surgeon and emergency department
• Patient is in dorsal lithotomy with Allen stirrups
• We use vaginoscopy, hysteroscopy, and 3 port laparoscopy in an attempt to gain additional detail in visualizing patient anatomy

Patients or Participants: Three patients with Mullerian anomalies consistent with Obstructed Hemivagina with Ipsilateral Renal Agenesis syndrome who underwent surgical management

Interventions:

• Vaginoscopy and hysteroscopy are used to identify at least one cervix and to survey uterine cavities for other potential issues.
• Laparoscopy allows recognition and confirmation of variations of Mullerian anomalies. It also allows direct visualization during hysteroscopic portion of case.

Measurements and Main Results: N/A

Conclusion:

• Obstructed hemivagina ipsilateral renal agenesis is a relatively rare condition in which adolescent patients can present in the acute or outpatient settings. For our case series, patients were identified to have anomalies preoperatively via imaging or prior workup.
• A combination of minimally invasive procedures including vaginoscopy, hysteroscopy, and laparoscopy are useful in the confirmation in Mullerian anomaly diagnosis, as well as surveillance of surgical treatment of Mullerian anomalies.