Definitive Management of C-Section Scar Ectopic Pregnancy with Robotic-Assisted Laparoscopic Total Hysterectomy

Abstract

<h3>Study Objective</h3> To describe an approach for treatment of c-section scar ectopic pregnancy in women who do not desire future fertility potential. <h3>Design</h3> This video describes the minimal invasive surgical approach for treatment of a CSP type1. <h3>Setting</h3> The robotic approach was utilized to offer better visualization and greater surgical dexterity for fine lysis of adhesions. <h3>Patients or Participants</h3> This case depicts a 38 y/o G4P2103 diagnosed as having a missed abortion at 7 weeks. However, on ultrasound a CSP was diagnosed. She was counseled on possible management approaches and elected to proceed with definitive surgical management. <h3>Interventions</h3> Intraoperatively, dense adhesions of the bladder were noted to the lower uterine segment. Once adhesiolysis was performed, CSP was identified bulging in the lower uterine segment covered by a thin layer of myometrium. Pathology confirmed gestational sac in the thin lower uterine segment consistent with the clinical impression of CSP. Excellent hemostasis was achieved. <h3>Measurements and Main Results</h3> Blood loss from surgery was 200 mL. Patient had an uncomplicated postoperative course and was discharged on POD# 0. <h3>Conclusion</h3> Robotic-assisted laparoscopic hysterectomy can be considered for treatment of CSP for women who do not desire future fertility potential.