title: Robotically assisted delayed total laparoscopic hysterectomy for placenta percreta.
abstract: BACKGROUND
  The prevalence of morbidly adherent placenta has dramatically increased in the setting of the rising cesarean rate in the United States. Delayed surgical management of placenta accreta and its variants is emerging as methods that may significantly decrease bleeding and perioperative complications; however, optimal surgical approaches have not yet been determined. In this report, we present a case of robotic-assisted delayed interval hysterectomy in a patient with placenta percreta.
  
  
  METHODS
  A minimally invasive approach, via a robotic-assisted total laparoscopic hysterectomy, was utilized for a 39-year-old gravida 9 para 3 with placenta percreta with placenta left in situ ten weeks after a tertiary cesarean section.
  
  
  RESULTS
  The robotic approach provided excellent visualization to facilitate fine planes of dissection, lower than expected estimated blood loss, and faster recover times when compared with conventional surgical approaches traditionally utilized for interval hysterectomies for placenta percreta.
  
  
  CONCLUSIONS
  Robotic-assisted hysterectomy may be considered as an alternative to laparotomy for the delayed interval surgical management of morbidly adherent placenta percreta.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA.
authors.forename: Devon M
authors.initials: DM
authors.lastname: Rupley
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Palmerola
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
keywords: Delayed hysterectomy; Laparoscopic hysterectomy; Minimally invasive surgery; Morbidly adherent placenta; Placenta percreta; Robotic surgery