title: Robotic-assisted Laparoscopic Repair of a Cesarean Section Scar Defect.
abstract: OBJECTIVE
  To describe our technique for the repair of a cesarean section uterine scar defect after removal of an ectopic pregnancy from the scar in a patient desiring future pregnancies.
  
  
  METHODS
  Step-by-step explanation of the procedure using video (Canadian Task Force classification III).
  
  
  METHODS
  Uterine scar dehiscence/defect is a known complications of multiple cesarean deliveries that can result in abnormal bleeding, infertility, and cesarean scar ectopic pregnancy. With the increasing number of cesarean sections performed in the United States, the prevalence of this complication is rising. Nonetheless, there currently are no standardized surgical treatment guidelines available to manage this pathology through a minimally invasive approach.
  
  
  METHODS
  In this video, we describe our technique for the surgical management of a symptomatic cesarean section scar defect. We performed a robotic-assisted laparoscopic repair of this defect in a 40-year-old G4P3013 with a recent cesarean section scar ectopic pregnancy managed by endometrial curettage, with subsequent persistent abnormal vaginal bleeding. A repeat ultrasound revealed a low uterine segment defect consistent with dehiscence. She was referred to us because she desired a conservative treatment given her desire for future pregnancies. The defect was localized by hysteroscopy and laparoscopy after developing the bladder flap. The scar tissue around the defect was resected, and the freshened edges of the defect were closed using delayed absorbable suture. Chromopertubation confirmed the watertightness of the repair. Postoperatively, the patient had regular normal periods, and her hysterosalpingogram didn't show any uterine defect.
  
  
  CONCLUSIONS
  Robotic-assisted laparoscopic repair of cesarean section scar defect is a feasible and safe procedure when done with respect to anatomy and following sound surgical technique. With the increasing number of cesarean sections, gynecologists will be dealing with this pathology more frequently, and need to become more familiar with different techniques that can be helpful in performing such a repair.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry and Minimally Invasive and Robotic Gynecologic Surgery, The Women's Health Center at Rochester General Hospital, Rochester, NY.
authors.forename: Mohamad S
authors.initials: MS
authors.lastname: Mahmoud
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mount Sinai St. Luke's and Mount Sinai Roosevelt, Mount Sinai Health System, New York, NY; Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook School of Medicine, Stony Brook, NY; Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY. Electronic address: fnezhat@chpnet.org.
authors.forename: Farr R
authors.initials: FR
authors.lastname: Nezhat
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Cesarean section dehiscence; Laparoscopic repair; Robotic repair of uterine defect; Uterine dehiscence