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Cesarean scar pregnancy : Reproductive outcome after robotic laparoscopic removal with simultaneous repair of the uterine defect

Hofgaard, Ellen ; Westman, Katarina ; Brunes, Malin ; Bossmar, Thomas LU and Persson, Jan LU (2021) In European Journal of Obstetrics and Gynecology and Reproductive Biology 262. p.40-44
Abstract

Objective: To describe perioperative adverse events, fertility and obstetric outcome, following a robot assisted laparoscopic approach for treating Cesarean scar pregnancies (CSP). Study Design: A retrospective case series of 14 consecutive women with a CSP and a wish for and attempts towards subsequent pregnancies, having undergone minimal invasive surgical treatment at two tertiary referral Swedish centers (Dep's of Obstetrics and Gynecology Skåne University Hospital, Lund, and Södersjukhuset, Stockholm) between 2008 and 2019. The surgery was performed by temporary intraoperative occlusion of the uterine blood supply, removal of the CSP and repair of the niche, by the use of robot assisted laparoscopy (Da Vinci surgical robot,... (More)

Objective: To describe perioperative adverse events, fertility and obstetric outcome, following a robot assisted laparoscopic approach for treating Cesarean scar pregnancies (CSP). Study Design: A retrospective case series of 14 consecutive women with a CSP and a wish for and attempts towards subsequent pregnancies, having undergone minimal invasive surgical treatment at two tertiary referral Swedish centers (Dep's of Obstetrics and Gynecology Skåne University Hospital, Lund, and Södersjukhuset, Stockholm) between 2008 and 2019. The surgery was performed by temporary intraoperative occlusion of the uterine blood supply, removal of the CSP and repair of the niche, by the use of robot assisted laparoscopy (Da Vinci surgical robot, Intuitive Surgical, Sunnyvale, CA). Results: All surgeries were uneventful with a median bleeding of 75 mL. One woman had a postoperative Clavien-Dindo complication grade IIIa (hysteroscopic resection of an isthmic synechiae). During follow up nine women (64 %) conceived naturally; eight of these had an uneventful pregnancy and a full-term Cesarean delivery and one had recurrent CSP and Cesarean with simultaneous hysterectomy in gestational week 33. Conclusion: A robotic removal of a CSP with simultaneous repair of the defect is a feasible option with acceptable reproductive outcome and should be considered when counseling women with a wish for future childbirth in cases of a live CSP and a thin, or absent, myometrium in the niche. A temporary intraoperative occlusion of the uterine blood supply may be useful in cases of live pregnancies and/or high serum β-hCG levels.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cesarean scar pregnancy, Fertility outcome, Robotic surgery
in
European Journal of Obstetrics and Gynecology and Reproductive Biology
volume
262
pages
5 pages
publisher
Elsevier
external identifiers
  • pmid:33984726
  • scopus:85105536208
ISSN
0301-2115
DOI
10.1016/j.ejogrb.2021.05.004
language
English
LU publication?
yes
id
b40b34ef-d828-4624-a026-936da5791fc7
date added to LUP
2021-05-27 14:38:23
date last changed
2025-03-09 13:19:07
@article{b40b34ef-d828-4624-a026-936da5791fc7,
  abstract     = {{<p>Objective: To describe perioperative adverse events, fertility and obstetric outcome, following a robot assisted laparoscopic approach for treating Cesarean scar pregnancies (CSP). Study Design: A retrospective case series of 14 consecutive women with a CSP and a wish for and attempts towards subsequent pregnancies, having undergone minimal invasive surgical treatment at two tertiary referral Swedish centers (Dep's of Obstetrics and Gynecology Skåne University Hospital, Lund, and Södersjukhuset, Stockholm) between 2008 and 2019. The surgery was performed by temporary intraoperative occlusion of the uterine blood supply, removal of the CSP and repair of the niche, by the use of robot assisted laparoscopy (Da Vinci surgical robot, Intuitive Surgical, Sunnyvale, CA). Results: All surgeries were uneventful with a median bleeding of 75 mL. One woman had a postoperative Clavien-Dindo complication grade IIIa (hysteroscopic resection of an isthmic synechiae). During follow up nine women (64 %) conceived naturally; eight of these had an uneventful pregnancy and a full-term Cesarean delivery and one had recurrent CSP and Cesarean with simultaneous hysterectomy in gestational week 33. Conclusion: A robotic removal of a CSP with simultaneous repair of the defect is a feasible option with acceptable reproductive outcome and should be considered when counseling women with a wish for future childbirth in cases of a live CSP and a thin, or absent, myometrium in the niche. A temporary intraoperative occlusion of the uterine blood supply may be useful in cases of live pregnancies and/or high serum β-hCG levels.</p>}},
  author       = {{Hofgaard, Ellen and Westman, Katarina and Brunes, Malin and Bossmar, Thomas and Persson, Jan}},
  issn         = {{0301-2115}},
  keywords     = {{Cesarean scar pregnancy; Fertility outcome; Robotic surgery}},
  language     = {{eng}},
  pages        = {{40--44}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Obstetrics and Gynecology and Reproductive Biology}},
  title        = {{Cesarean scar pregnancy : Reproductive outcome after robotic laparoscopic removal with simultaneous repair of the uterine defect}},
  url          = {{http://dx.doi.org/10.1016/j.ejogrb.2021.05.004}},
  doi          = {{10.1016/j.ejogrb.2021.05.004}},
  volume       = {{262}},
  year         = {{2021}},
}