Design: The study employs a case-study design, focusing on a single patient treated with a robotic-assisted laparoscopic approach to address uterine fibroids in the context of MRKH Syndrome.

Setting: MRKH Syndrome is a rare congenital anomaly characterized by the absence of the uterus and upper vagina, complicating standard gynecological surgeries due to distorted pelvic anatomy. The surgical setting required specialized robotic equipment to enhance precision and visualization.

Patients or Participants: A 38-year-old female with a longstanding diagnosis of MRKH Syndrome presented with chronic pelvic pain and palpable masses, later identified as uterine fibroids via MRI. She represented a unique case due to the presence of rudimentary uterine structures.

Interventions: The intervention consisted of a robotic-assisted laparoscopic approach to perform a hysterectomy of the rudimentary uterus, remove fibroids, and conduct bilateral salpingo-oophorectomy. Advanced robotic tools facilitated delicate dissection and removal in the anatomically challenging environment.

Measurements and Main Results: The main outcomes measured were the successful removal of fibroids and associated structures, confirmed by pathology to be benign leiomyomas. Post-surgery, the patient reported significant relief from pelvic pain and no operative complications, highlighting the intervention's success.

Conclusion: Mullerian malformations are rare and can be a challenging condition for the gynecological surgeon when surgery is needed. In those cases, careful diagnostic investigation must be enforced, and robot assisted laparoscopy stands out as an important tool. It allows precise visualization of pelvic structures and anatomy, not to mention its delicate movements, such as joint and circular movements, that can facilitate the surgical manipulation of a distorted anatomy.