A Case of Déjà Vu: Surgical Correction of a Uterine Avm and Hysteroscopic Resection of Rpoc Secondary to Invasive Placenta

Abstract

<h3>Study Objective</h3> To demonstrate a unique case of both a laparoscopic correction of a uterine AVM and hysteroscopic resection of retained products of conception secondary to invasive placenta. <h3>Design</h3> A brief literature review and case report with demonstration of surgical technique. <h3>Setting</h3> Operating Room environment. <h3>Patients or Participants</h3> In this video we explore the case of a 28-year-old patient who in 2019 had a 20-week loss followed by PPH requiring manual removal of retained placenta and D&C. Subsequent to this first pregnancy she a delayed PPH with IR embolization of the left uterine artery for a uterine AVM. In 2020, the patient delivered vaginally, preterm at 27 weeks and again had a PPH requiring manual removal of retained placenta and D&C. After 2 months of continued spotting an ultrasound queried residual RPOC with hypervascularity in the right uterine wall suggestive of a right AVM with CT angiography confirming a uterine AVM. <h3>Interventions</h3> The patient wished for fertility preservation and ultimately underwent laparoscopic clipping of the feeding vessel, the right internal iliac artery followed by hysteroscopic removal of retained products of conception. <h3>Measurements and Main Results</h3> The patient's post-operative course was uncomplicated and final pathology confirmed normal placental tissue consistent with placenta accreta. The post-op sonohysterogram confirmed an empty uterine cavity and the 2D colour doppler US confirmed reduced right uterine wall vascularity. <h3>Conclusion</h3> A laparoscopic approach to uterine AVM management is possible and can be combined with hysteroscopic investigation and management of RPOC.