Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series

Abstract

Objective This study aimed to describe a novel surgical technique for the management of antenatally suspected placenta accreta spectrum (PAS). Study Design This is a retrospective, case series of patients with suspected PAS undergoing peripartum hysterectomy with a reloadable articulating stapler at a tertiary care center. Results Eighteen patients with antenatally suspected PAS were identified and underwent peripartum hysterectomy with the aid of a reloadable stapler. Mean gestational age at delivery was 344/7 ± 11/7 weeks. Mean total operative time (skin-to-skin) was 117.3 ± 39.3 minutes, and 79.8 ± 19.8 minutes for the hysterectomy. Mean blood loss for the entire case was 1,809 ± 868 mL. Mean blood loss for the hysterectomy was 431 ± 421 mL. Mean units of intraoperative red blood cells transfused was 3 ± 1 units. Mean units of postoperative red blood cells transfused was 1 ± 0.5 units. Five cases were complicated by urological injury (two intentional cystotomies). Four patients were admitted to the intensive care unit (ICU) for a mean of ≤24 hours. Mean postoperative LOS was 4.11 ± 1.45 days. Three patients had final pathology that did not demonstrate PAS while four were consistent with accreta, six increta, and five percreta. Conclusion Use of a reloadable articulating stapler device as part of the surgical management of antenatally suspected PAS results in a shorter operative time (117 ± 39 minutes vs. 140–254 minutes previously reported), lower average blood loss (1,809 ± 868 mL vs. 2,500–5,000 mL previously reported) and shorter LOS (4.11 ± 1.45 days vs. 9.8 ± 13.5 days previously reported) compared with traditional cesarean hysterectomy. The reloadable stapling device offers an advantage of more rapidly achieving hemostasis in the surgical management of PAS. Key Points

Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta‐analysis

“…The initial search resulted in 856 articles, of which 758 were excluded, as the reported outcomes were not relevant, leaving 98 studies that were obtained for full‐text review. An additional 36 articles were excluded after full review, leaving 62 articles for the systematic review 18–79 (Figure 1 and Tables 1 and S2). Of these, 56 studies were included in the meta‐analysis 18–24, 26–33,35–44,46–61,63–69,71–77,79 , while six studies were excluded from the pooled analysis due to potential overlap in populations.…”

“…When considering only studies with ≥ 12 cases per year, the incidence of urological complications was similar to that reported in the primary analysis (Table S3). 18 Erfani (2022) 29 Kuznetsova (2022) 19 Munoz (2022) 20 Overton (2022) 21 Pav ón-Gomez (2022) 22 Scaglione (2022) 23 Sentilhes (2022) 24 Smith (2022) 25 Taskeen (2022) 26 Uddén (2022) 34 Xin (2022) 27 Bakacak (2021) 28 Celik (2021) 40 Crocetto (2021) 41 Matsuzaki (2021) 30 Morlando (2021) 31 Nieto-Calvache (2021) 43 Parveen (2021) 32 Soleymani Majd (2021) 33 van Beekhuizen (2021) 35 Chahal (2020) 36 Dall'Asta (2020) 37 Nisar (2020) 38 Zuckerwise (2020) 45 Alanwar (2019) 52 Dawood (2019) 42 Meller (2019) 47 Sak (2019) 44 Shmakov (2019) 49 Marcellin (2018) 46 Özcan (2018) 48 Pala (2018) 54 Saha (2018) 39 Thabet (2018) 50 Zhao (2018) 51 Chaudhari (2017) 55 Karaman (2017) 56 Lee (2017) 53 Camuzcuoglu (2016) 57 Norris (2016) 59 Thurn (2016) 61 Shabana (2015) 60 Shams...…”