Robotic Resection and Revision of Uterine Scar Defect with Hysteroscopic Guidance

Abstract

Study Objective To demonstrate the steps of a robotic-assisted resection and revision of a uterine scar defect with hysteroscopic guidance and review tips and trips for this rare surgical procedure. Design This video describes the step by step approach to a robotic resection and revision of a uterine scar defect using hysteroscopic guidance to identify the target anatomy. Additionally, we describe tips and tricks to utilize while performing this rare surgical procedure to facilitate identification of the uterine scar laparoscopically, resect the defect in its entirety, improve hemostasis, and place a supportive suture for revision. Setting The patient was placed in dorsal lithotomy position in preparation for both hysteroscopic and robotic access. Patients or Participants In this surgical video, we present a case of a women with secondary infertility and a uterine scar defect in the setting of a history of prior cesarean delivery. She was referred by an REI physician due to history of aborted embryo transfers with abnormal fluid collections in the uterine defect. Interventions Robotic-assisted resection and revision of the uterine scar defect with hysteroscopic guidance. Measurements and Main Results Complete resection and reapproximation of the defect was visualized both laparoscopically and hysteroscopically without evidence of leakage of hysteroscopic fluid through the incision. Conclusion A minimally invasive approach to uterine scar defects can utilize simultaneous robotic-assisted laparoscopy and hysteroscopic guidance to identify the defect for resection and revision in symptomatic women or for fertility indications.