Techniques for robotic isthmocele resection
Objective: Abdominal isthmocele resection, when clinically indicated, can be challenging to identify intra-operatively. In this video we present multiple techniques to properly identify the isthmocele for complete excision. Description: Our patient is a 33-year-old para 1 with a history of preterm cesarean delivery followed by subsequent cesarean scar ectopic treated with intramuscular methotrexate. Given her desire for future fertility, she opted for surgical management of her isthmocele, via the robotic assisted laparoscopic approach. Several techniques were employed during the procedure to achieve a complete resection of the defect. Pre-operative MRI imaging allowed for intra-operative measurement comparison using a sterile ruler. Vasopressin was injected trans-abdominally which allowed for excellent hemostasis during the resection and closure. The simultaneous use of hysteroscopy and laparoscopy allowed visualization of the hysteroscopic light from the laparoscopic camera. Use of the robotic firefly function enhanced the visualization of the full scar defect. A hysteroscopic needle placed at the apex of the defect, along with measurements from the sterile ruler, helped identify the extent of the isthmocele, and monopolar scissors were used to mark the site of excision. Conclusion: This video has provided educational demonstrations of surgical techniques to allow for complete isthmocele resection.
American Journal of Obstetrics and Gynecology
Dreibelbis, S., Collett, A. E., & Pugh, C. J. (2023). Techniques for robotic isthmocele resection. American Journal of Obstetrics and Gynecology, 228 (3), S939. https://doi.org/10.1016/j.ajog.2022.12.25