# A combined laparoscopic and vaginal approach with a novel method to reconstructing the uterine cervix in Herlyn-Werner-Wunderlich syndrome with cervical obstruction: A case report

## TL;DR

A new surgical method combining laparoscopic and vaginal approaches was developed to treat a rare uterine malformation syndrome with cervical obstruction, successfully preventing restenosis.

## Contribution

A novel combined laparoscopic and vaginal surgical technique using a catheter-fixed IUD to reconstruct the cervix in Herlyn-Werner-Wunderlich syndrome.

## Key findings

- The combined approach allowed successful reconstruction of the uterine cervix and prevention of restenosis.
- Postoperative follow-up showed no recurrence of symptoms after 24 months.
- Laparoscopy proved valuable for evaluating and treating complex genital malformations.

## Abstract

Herlyn-Werner-Wunderlich syndrome (HWWS) is characterized by uterine didelphys, unilateral cervical obstruction, and ipsilateral renal defects. Owing to its rarity, no standard surgical approach exists.

An 11-year-old girl with severe dysmenorrhea had a duplicated uterus, a right cervical hemorrhagic cyst, and right ipsilateral kidney agenesis, indicative of HWWS. As transvaginal surgery was challenging, we turned to laparoscopic surgery for abdominal cavity inspection and surgical assistance. A longitudinal incision was made on the right uterus, followed by inserting a catheter tube fixed to an intrauterine device (IUD) into the right cervical canal from the anterior wall of the right uterine horn. Subsequently, the right external cervical os was inverted to prevent restenosis. Postoperatively, the hemorrhagic cyst at the right cervix disappeared. The patient had no symptom recurrence 24 months after the surgery.

The preoperative diagnosis for female genital malformations is complicated, and transvaginal manipulation is often difficult in adolescent girls. Laparoscopy is a valuable tool for evaluating female genital malformations, allowing for a thorough diagnosis and safe surgical treatment. In cases of female genital malformation with cervical obstruction, as in this case, reconstruction of the uterine cervix is important to prevent restenosis after surgery.

In female genital malformations, laparoscopy provides a comprehensive evaluation of the malformation, assisting in a precise diagnosis and safe surgical treatment. Insertion of the catheter tube with IUD into the uterus and reconstruction of the cervix contribute to preventing restenosis.

•A typical surgical procedure for Herlyn-Werner-Wunderlich syndrome with cervical obstruction has not yet been established.•We devised a new method by a combined laparoscopic and vaginal approach using a catheter tube fixed to an intrauterine device.•A thorough evaluation of the malformation and visualization of the abdominal cavity is necessary for safe surgical treatment.•Particular attention should be given to patients with cervical obstructions to prevent restenosis after surgery.

A typical surgical procedure for Herlyn-Werner-Wunderlich syndrome with cervical obstruction has not yet been established.

We devised a new method by a combined laparoscopic and vaginal approach using a catheter tube fixed to an intrauterine device.

A thorough evaluation of the malformation and visualization of the abdominal cavity is necessary for safe surgical treatment.

Particular attention should be given to patients with cervical obstructions to prevent restenosis after surgery.