Robotic management of a ruptured rudimentary horn pregnancy

Unicornuate uterus results from incomplete Müllerian duct development and often includes a rudimentary horn. Pregnancy in such a rudimentary horn is rare. The video presents the robotic management of a 21-week, ruptured rudimentary horn pregnancy, emphasizing preoperative planning and surgical excision using a robotic platform, highlighting a novel minimally invasive technique for this rare obstetric emergency. A primigravida with a unicornuate uterus presented with a ruptured rudimentary horn pregnancy at 21 weeks and 4 days of gestation. Imaging confirmed fetal expulsion into the peritoneal cavity with moderate hemoperitoneum. The patient underwent right internal iliac artery embolization to minimize blood loss, followed by robotic excision of the ruptured horn, fetus, and placenta through posterior colpotomy. The procedure was completed using a multiport robotic setup with minimal intraoperative blood loss. The surgery was completed in 45 minutes with minimal complications. The patient had an uneventful postoperative recovery. Robotic-assisted surgery provides a safe, minimally invasive alternative to laparotomy for ruptured rudimentary horn pregnancies in well-selected patients. Meticulous planning, patient selection, and a multidisciplinary approach are key to success.