Abstract
Video Objective To describe a technique of robotic-assisted laparoscopic hysterectomy of a second trimester gravid uterus with placenta percreta Setting A step-by-step explanation of the surgery using video (instructive video). Interventions In this video, we describe the surgical approach opted for this patient desiring pregnancy termination and no desire for future fertility. Minimally invasive surgery was recommended considering decreased blood loss, postoperative pain and hospital stay. Also considering her prior surgical history, the laparoscopic approach would offer better visualization for lysis of adhesions. Intraoperatively, the uterus was found to have adhesions anteriorly to the abdominal wall as well as bladder adhesions to the lower uterine segment. Generalized increased vascularity was observed. The blood supply from the utero-ovarian and the uterine vessels were tackled prior to releasing the adhesion of the anterior wall of the uterus to the anterior abdominal wall. The lower uterine segment was adherent to the bladder, thereby the lateral approach was used to enter the paravesicular space to create a bladder flap to mobilize the bladder inferiorly. An End to End (EEA) sizer was used to identify the colpotomy site. The cardinal ligament were coagulated and transected to lateralize the paracervical tissue. The colpotomy was then performed and the specimen was then exteriorized intact vaginally. The vaginal cuff was then closed in a continuous fashion using 0-VLoc. Estimate blood loss was 300mL. Postoperatively, patient was hemodynamically stable, and post-operative labs were found to be within normal limits. Patient was discharged in stable condition on post-operative day one. Conclusion Robot assisted hysterectomy is feasible and superior to open approach in a patient with a second trimester pregnancy complicated by placenta percreta with completion of child bearing.
Published Version
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