Just as I started doing some crunches, the phone rang. This is typical as of late. Every time I begin exercising the phone magically starts ringing. Thankfully I heard it, and ran to snag it before hitting voicemail. It was Ms. Really Friendly from the RE’s office to give me the details about my lap.
Thursday, April 26th, I go at 8 am for a round with the vampires (I use that word most affectionately for the wonderful phlebotomists at my RE’s office.) Of course, they will make sure I’m not pregnant (funny bunch over there aren’t they!) A transvaginal ultrasound will be performed, to get the most up to date view of what my uterus looks like. They will make sure I’m healthy and good to go. I will also have a pre-op appointment with Dr. Local. The 27th I will be at the hospital at 12:30 for a cross your fingers because I’m going to be starving time of 2:30 pm. My anotomy will dictate how long the surgery will take.
Ms. Really Friendly told me that this will most likely be inpatient. You’ll see why in the paragraphs that follow. Drumroll please….
Let’s first start with how I ended up with my uterus in this condition. Thanks to e-medicine for the info!
“At about two months of pregnancy, the uterus in a female fetus begins to form. It develops from two tubelike structures called the Mullerian ducts. As the baby grows, these tubes enlarge and their middle portions fuse together to form the uterus. The upper portions of these ducts go on to form the fallopian tubes. The fused tubes continue to grow; as the uterus enlarges, the area where the tubes touch each other dissolves, leaving one hollow muscular tube — the uterine cavity.
It is a miracle how this chain of events happens. Yet things can go wrong. The ducts may not merge; the result is a double uterus. The ducts may merge incompletely, creating a heart-shaped (bicornuate) uterus. One of the ducts may fail to develop, forming a single-horned (unicornuate) uterus with only one fallopian tube. Or the ducts fuse, but the area where they joined does not dissolve, leaving a dividing wall inside the uterine cavity — a uterine septum.”
Below is an actual picture of a bicornuate uterus. The woman did conceive and give birth to children. 
Ok, here’s the deal. If I have what is called a non-communicating horn, which means there is no continuity with the main uterine cavity, they will perform an open hemi-hysterectomy. Naturally, that scares the ever loving crap out of me. Why? Read how they do it below. If the non-communicating horn is not removed it can hinder a pregnancy. The reproductive endocrinologist (RE) believes I have a non-communicating horn and this is most likely what will happen. However, if I have a communicating horn, then he will do nothing. If I have a septum they will remove it.
I was given this information, which is for a unicornuate uterus, but is nearly the same for a bicornuate one. Here’s the technical breakdown:
Surgical technique for rudimentary horn excision “Excision of an accessory horn is accomplished by means of laparoscopic hemihysterectomy. The bladder is emptied through the insertion of a Foley catheter. The standard 3-part set-up is used, including 2 lateral ports and a medial port. A tenaculum is used for uterine mobilization. The reproductive organs are examined for any other abnormalities. Anatomic variations of horn attachment to the unicornuate uterus exist. A fibromuscular band often connects the 2 horns. In this setting, the uterine artery courses inferior to the band and can be easily coagulated. The band is desiccated by using bipolar cautery and transected. On occasion, the horn can be firmly attached to the unicornuate uterus. In this setting, the uterine artery courses inferior to the horn and lateral to the unicornuate uterus. The pedicle of the rudimentary horn is coagulated using bipolar coagulation. Scissor division is performed close to the desiccation line to ensure that the compressed pedicle remains intact. The mesosalpinx is cauterized and cut, allowing removal of the fallopian tube. The peritoneum of the vesicouterine space can be grasped and elevated with forceps, while the vesicouterine space is dissected by using scissors. Aquadissection may be used to separate the leaves of the broad ligament. The vesicouterine space is distended, and the bladder attachments are coagulated and cut. The tube and rudimentary horn are removed, leaving the functional ovary. Dissection is more complicated when the horns are not externally separated. The myometrium is resected at the junction of the horns by using bipolar coagulation followed by mechanical or laser cutting. After the myometrium resection is complete, the rudimentary horn can be removed. Morcellation is often required when the rudimentary horn is large (Nisolle, 1996; Donnez, 1997).
In the event a pregnancy occurs in a noncommunicating horn, laparoscopic excision of the pregnant horn is advocated. Excision of the pregnant horn is similar to that performed for nonpregnant horns, though one must be mindful of increased pedicle vascularity. Successful pregnancy in the major horn has been reported after laparoscopic removal of accessory horn (Adolph, 2004). Cutner and coworkers (2004) reported their experience with 2 pregnancies in noncommunicating horns. The pregnancies were medically treated with methotrexate before horn excision. The authors concluded that this approach allowed the excision to be delayed to a safe and less invasive time.
Endometrial ablation of accessory horn endometrium through a hysteroscopic approach is reported for treatment of symptomatic hematometra. At 3-year follow-up, patients were free of symptoms. Neither hematometra nor dysmenorrhea had recurred (Hucke, 1992). Hysteroscopic drainage of a hematometra in a noncommunicating accessory horn by using electrocautery to create a communication between the horns has been also described. At 1 month follow-up a single uterine cavity was identified and there was complete symptom relief (Nogueria, 1999). Additional studies are needed before these treatment modalities are widely accepted.”
Yes, thank you again e-Medicine for your insanely complicated information!
**I’ll write tomorrow about how I feel about the lap. Today technical details, tomorrow emotional ones.**
