55: Robot-assisted multiport hysterotomy with resection of cesarean scar ectopic pregnancy involving the cervix and metroplasty

Abstract

OBJECTIVES: To demonstrate a minimally invasive robot-assisted technique to resect a cesarean scar ectopic pregnancy also involving the cervix and subsequent metroplasty. DESCRIPTION: Cesarean scar ectopic pregnancy occurs in approximately 1 in 2000 pregnancies and has the potential to cause significant maternal morbidity and mortality due to risk of hemorrhage. It is unclear the most effective treatment of cesarean scar pregnancy due to limited available data. The case presented is a 30-year old female gravida two para one at 15 weeks gestation with cesarean scar ectopic pregnancy who underwent a robot-assisted resection after failed methotrexate treatment. After placement of the robotic port sites, the bladder flap was developed distal to the cervix. A large window was visualized in the lower uterine segment and cervical region. The cesarean scar ectopic was visualized involving also the cervical region just above the internal os; this was resected until normal myometrium was encountered. The myometrium was subsequently re-approximated in layers of 2-0-Monocryl suture. Hysteroscopy was then performed, where the sutures were visualized and the endocervical canal verified to be patent. Post-operative imaging revealed resolution of previously visualized ectopic pregnancy as well as a reinforced anterior lower uterine segment myometrium. CONCLUSION: Robot-assisted resection of cesarean scar ectopic pregnancy and metroplasty is a safe and feasible method for treatment of a cesarean scar ectopic pregnancy also involving the cervix.