The Role of Laparoscopic Surgery in Gynecological Congenital Anomalies

Müllerian duct anomalies (MDAs) comprise a heterogeneous group of congenital malformations of the uterus, cervix and vagina that can impair menstruation, sexual function and fertility. Over the past three decades, minimally invasive techniques have largely replaced laparotomy for their surgical management; yet, data remain fragmented across small series and diverse anomaly types.

To synthesize contemporary evidence on laparoscopic and robotic management of MDAs, highlighting indications, key surgical techniques and reproductive and functional outcomes, while addressing psychosocial and ethical considerations.

A comprehensive narrative review was conducted in PubMed, Scopus and Google Scholar (January 1995-June 2024) using predefined Boolean combinations for specific anomalies and minimally invasive procedures. We included English-language, peer-reviewed clinical studies and sizable case series (n ≥ 3) reporting laparoscopic, laparoscopic-assisted, or robotic management of congenital uterine, cervical, or vaginal anomalies. The review was designed and reported in accordance with SANRA guidelines for narrative reviews.

Laparoscopy has become central to the management of fusion and obstructive anomalies. Laparoscopic Strassman metroplasty in selected bicornuate uteri and laparoscopic excision of rudimentary horns in unicornuate uteri achieve high rates of symptom relief, reduction in miscarriage risk, and subsequent term pregnancies, with fewer adhesions than open surgery. In uterus didelphys and obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), combined vaginal and laparoscopic approaches effectively relieve obstruction while preserving the functional uterus. For vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome, laparoscopic Vecchietti, Davydov and sigmoid vaginoplasties consistently provide anatomically adequate neovaginas and satisfactory sexual function. Robotic assistance facilitates complex suturing in selected reconstructions, but clear superiority over conventional laparoscopy has not been demonstrated.

Minimally invasive surgery has transformed the management of MDAs by enabling effective correction of complex malformations with reduced morbidity and favorable reproductive and functional outcomes in appropriately selected patients. However, the evidence base is dominated by observational studies from specialized centers, with limited standardized reporting of fertility and psychosexual endpoints. Future multicenter, prospective research integrating uniform classification, core outcome sets and long-term psychosocial follow-up is needed to refine patient selection and optimize care pathways.