Laparoscopic Resection of Cesarean Scar Pregnancy at 11 Weeks Gestational Age

Abstract

<h3>Study Objective</h3> To demonstrate a laparoscopic technique for resection of cesarean scar pregnancy (CSP) and revision of cesarean scar defect. <h3>Design</h3> We present a stepwise narrated demonstration of our technique of a resection of a CSP. <h3>Setting</h3> Referral Center in NY. <h3>Patients or Participants</h3> 33-year-old with cesarean scar pregnancy at 11 weeks gestational age, desiring fertility sparing treatment <h3>Interventions</h3> A retroperitoneal dissection is performed, and the uterine blood supply is isolated<b>.</b> Hemostatic control is achieved with the use of intrauterine vasopressin and temporary occlusion of the uterine blood supply. The bladder is carefully dissected from the lower uterine segment and cesarean scar pregnancy. Ultrasound guidance is used to assist in hysterotomy location for resection of the ectopic pregnancy. The myometrium is repaired with a 3-layer closure. Uterine ventrosuspension by plication of the round ligaments bilaterally results in anteversion of the previously sharply retroverted uterus, reducing tension on the repair. Hysteroscopy under laparoscopic visualization confirms repair of the scar defect. <h3>Measurements and Main Results</h3> Successful laparoscopic resection of a cesarean scar ectopic pregnancy and resection of scar defect with EBL of 250 mL. Patient discharged home postoperative day one. Normal appearing uterus on 3-month follow-up MRI with no residual cesarean scar defect and residual myometrial thickness of 1.6 cm. <h3>Conclusion</h3> Laparoscopic resection provides a means of addressing cesarean scar pregnancy at advanced gestational age while repairing the associated cesarean scar defect. Control of the uterine blood supply and mobilization of the bladder are critical aspects of the surgery. Intraoperative ultrasound and laparoscopic guided hysteroscopy can ensure full resection of the defect and achieve optimal repair. For the retroverted uterus, ventrosuspension may avoid tension on the repair to promote healing. For this patient, our technique resulted in no residual cesarean scar defect on follow-up imaging.