title: Robot-assisted laparoscopic surgery of a 12-week scar pregnancy with temporary occlusion of the uterine blood supply.
abstract: A Cesarean section scar pregnancy is a serious obstetric complication. For all treatment modalities there are risks of heavy bleeding and emergency hysterectomy. Here we report the use of the da Vinci robot for removal of the pregnancy with adequate bleeding control. A 36-year-old para-3 was diagnosed having a 11 + 3 week live cesarean scar pregnancy and a complete placenta previa. S-hCG was 52 726 IU/l. One week after methotrexate treatment the pregnancy was uneventfully and completely removed by robot-assisted laparoscopy with minimal blood loss. The uterine defect was repaired. Bleeding was controlled by temporary application of metal clips to the distal internal iliac arteries and the propria ligaments. Postoperative color Doppler ultrasonography revealed normal uterine blood flow, a repaired uterine defect, and no remaining pregnancy tissue. S-hCG was normalized (<3 IU/l) 38 days after surgery. Robot-assisted laparoscopic surgery with temporary occlusion of the main uterine blood supply is a feasible and safe technique for surgery of a Cesarean scar pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Lund University Hospital, 221 85, Lund, Sweden. jan.persson@med.lu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Persson
authors.affiliation: Department of Obstetrics and Gynecology, Lund University Hospital, 221 85, Lund, Sweden.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Gunnarson
authors.affiliation: Department of Obstetrics and Gynecology, Lund University Hospital, 221 85, Lund, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindahl
keywords: Robot assisted surgery; Scar pregnancy