title: Robotic-Assisted Laparoscopic Treatment of Residual Ectopic Pregnancy in a Previous Cesarean Section Scar: A Case Report.
abstract: To describe a technique of robotic-assisted laparoscopy of residual cesarean scar pregnancy (CSP) and uterine defect repair.
  
  
  
  Video case report, with step-by-step explanation of the procedure (Canadian Task Force classification III) SETTING: CSP may be treated by different approaches including surgery and methotrexate. Successful methotrexate treatments avoid an emergency surgical treatment. In these cases a residual CSP often remains and should be removed in women who desire to conceive. CSP is often associated with a cesarean section scar defect called an isthmocele. In case of isthmocele with important defect and desire for pregnancy, laparoscopic repair may be proposed. Diagnosis and treatment of isthmocele is usually performed in a second time after a successful treatment of CSP. In this case, a surgical treatment including the removal of the residual CSP and treatment of the isthmocele may be proposed.
  
  
  
  In this video we describe a technique for the surgical removal of residual CSP and isthmocele treatment by robotic-assisted laparoscopy. A 32-year-old patient developed a CSP treated by 2 in situ injections of methotrexate. A magnetic resonance imaging study performed 1 month after the last methotrexate injection revealed a persistent 4-cm residual CSP, associated with an isthmocele. Preoperative uterine artery embolization was performed to reduce intraoperative bleeding. After localization of the residual CSP on the left side, a temporary left uterine occlusion was performed. Residual CSP was totally removed. The residual defect and isthmocele were closed using delayed absorbable suture.
  
  
  
  Robotic-assisted laparoscopic removal of residual CSP and isthmocele treatment is a feasible and safe procedure. This procedure may be proposed in patients presenting with this condition after a methotrexate treatment of CSP.
authors.affiliation: Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, Marseille, France.
authors.forename: Andy
authors.initials: A
authors.lastname: Schmitt
authors.affiliation: Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, Marseille, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Crochet
authors.affiliation: Pôle de gynécologie-obstétrique et reproduction, Gynepôle, AP-HM Hôpital de la Conception, Marseille, France. Electronic address: Aubert.AGOSTINI@ap-hm.fr.
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008727:Methotrexate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods; D014599:Uterus / Q000473:pathology / Q000601:surgery; D014945:Wound Healing
chemical_list: D008727:Methotrexate
keywords: Cesarean scar pregnancy; ectopic pregnancy; laparoscopic repair; robotic-assisted laparoscopy