Robotic Assisted Laparoscopic Repair with Acell Extracellular Matrix Reinforcement of Recurrent Trans-Mural Isthmocele

Abstract

Study Objective To illustrate the use of robotic surgery in repairing a recurrent trans-mural isthmocele using Acell extracellular matrix as reinforcement following treatment of a cesarean scar ectopic pregnancy. Design N/A Setting 36 year old G4P1031 with a history of cesarean scar ectopic managed with intramuscular and intragestational sac methotrexate presented with a full thickness transmural isthmocele. She underwent a robotic assisted laparoscopic repair of the isthmocele. Office hysteroscopy following the surgery demonstrated resolution of the uterine defect. A recurrence of the full thickness defect in the anterior uterine wall resulting in a diverticulum was noted on hystosalpingogram and confirmed with pelvic MRI during her infertility workup. Patients or Participants N/A Interventions Patient underwent a combined hysteroscopic guided via transillumination and robotic assisted laparoscopic trans-mural isthmocele repair with Acell extracellular matrix reinforcement. Measurements and Main Results N/A Conclusion The initial cesarean scar ectopic pregnancy was treated with methotrexate with trans-mural isthmocele as a sequela. Without a clearly defined gold standard in the literature for repairing recurrent trans-mural isthmocele, laparoscopy provides a minimally invasive approach. However, the recurrence rate of isthmocele following laparoscopic repair is unknown. Acell extracellular matrix has been used for other gynecologic procedures because of its ability to optimize the strength of the repair where scarring would be expected by promoting and facilitating the body's ability to remodel functional native tissue while minimizing the risk of foreign body response. The use of Acell in robotic assisted laparoscopic application for the reinforcement of isthmocele repair has not been previously described.