# Vaginal Hysterectomy of the Didelphic Uterus

## TL;DR

This paper discusses a successful vaginal hysterectomy for a rare uterine condition, showing it's a viable minimally invasive option.

## Contribution

The paper introduces surgical modifications enabling vaginal hysterectomy for a didelphic uterus, expanding minimally invasive options.

## Key findings

- Staged transection of uterosacral ligaments facilitated posterior colpotomy.
- Morcellation and uterine inversion enabled successful vaginal delivery of an enlarged didelphic uterus.
- The vaginal approach is feasible for didelphic uteruses, supporting minimally invasive hysterectomy for benign cases.

## Abstract

Hysterectomy of the didelphic uterus is extensively documented utilizing the laparoscopic and abdominal surgical approach with very few cases documenting the vaginal approach. This report will discuss the surgical modifications to the vaginal hysterectomy (VH) technique successfully employed in a case of a didelphic uterus. These techniques include staged transection of the uterosacral ligaments for the difficult posterior colpotomy, morcellation for the enlarged size of the uterus, and inversion of the uterus for delivery through the vaginal canal. This case displays the feasibility of the vaginal route for the didelphic uterus and augments the American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 701 by expanding the patient pathology that qualifies for benign indications for hysterectomy through the most minimally invasive route.