Robotic resection of a rudimentary horn pregnancy with the Da Vinci system: first case and systematic review of published cases in the 21st century.

BACKGROUND

Rudimentary horn pregnancy is a rare, high-risk ectopic gestation associated with significant maternal and fetal morbidity. Advances in minimally invasive surgery have expanded management options, but robotic-assisted resections have not been previously reported.

OBJECTIVES

This study aims to present the first robotic resection of a non-communicating rudimentary horn pregnancy and systematically review all published cases from 2000 onward to summarize diagnostic and management outcomes.

DATA SOURCES: A systematic literature search was conducted in PubMed up to August 14, 2025.

ELIGIBILITY CRITERIA: We included English-language case reports and series of non-communicating rudimentary horn pregnancies published from 2000 onward.

METHODS

Data on patient characteristics, diagnostic modalities, management strategies, and maternal-fetal outcomes were extracted following PRISMA 2020 guidelines.

RESULTS

The review identified 187 cases across 163 publications. Most pregnancies were diagnosed intraoperatively, with rupture occurring in 44%-predominantly during the second trimester-and a maternal mortality rate of 1.2%. Placenta accreta spectrum was reported in 39% of cases. Minimally invasive procedures, including our published robotic approach, are increasingly used in selected stable patients.

LIMITATIONS: The evidence is based primarily on retrospective case reports, which are prone to publication bias and heterogeneity.

CONCLUSIONS

Rudimentary horn pregnancy poses significant diagnostic and surgical challenges with high risk of rupture. Early recognition and minimally invasive management-including robotic surgery-may improve outcomes. Continued systematic reporting is critical to guide clinical practice.