Article (Scientific journals)
Laparoscopic approach for a cesarean scar pregnancy.
Karampelas, Stavros; Engels, Sara; Birbarah, Christian et al.
2022In Fertility and Sterility, 117 (5), p. 1099 - 1101
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Keywords :
Laparoscopy; minimal invasive surgery; scar ectopic pregnancy; uterine scar repair; Abdominal Pain; Adult; Cesarean Section/adverse effects; Cicatrix/diagnostic imaging; Cicatrix/etiology; Cicatrix/surgery; Female; Humans; Pregnancy; Uterine Hemorrhage/complications; Laparoscopy/adverse effects; Laparoscopy/methods; Pregnancy, Ectopic/diagnostic imaging; Pregnancy, Ectopic/etiology; Cesarean Section; Cicatrix; Pregnancy, Ectopic; Uterine Hemorrhage; Reproductive Medicine; Obstetrics and Gynecology
Abstract :
[en] ("[en] OBJECTIVE: To describe a surgical technique of laparoscopic resection of a cesarean scar pregnancy (CSP) with an immediate myometrial reconstruction. The advantage of such a technique is that it is a minimally-invasive procedure that can treat the ectopic pregnancy and the defected scar at the same time with good postoperative results. DESIGN: Video article with the description of a surgical minimally-invasive technique. SETTING: Academic medical center. PATIENT(S): A 34-year-old patient, Gravida 6 Para 4 Abortus 1, with a history of 4 previous cesarean sections presented to the emergency department with abdominal pain and vaginal bleeding. The patient was hemodynamically stable. An endovaginal ultrasound revealed a viable pregnancy of 8 weeks implanted in the cesarean scar, with a residual myometrium of <1 mm. Because of increasing abdominal pain, vaginal bleeding, and a desire to preserve future fertility, an emergent laparoscopy was performed. INTERVENTION(S): Laparoscopy was performed using a CO2 AcuPulse laser device (Lumenis Inc. Salt Lake City, Utah). A continuous wave mode was used, with a power of 30 Watt and a round-shaped beam of 1.5 mm in diameter. The laser was connected to a 10-mm Hopkins endoscope 0° (Karl Storz, Tuttlingen, Germany). A complete adhesiolysis was performed, and the urinary bladder was detached from the anterior abdominal wall. The vesicouterine fold was opened to expose the isthmic part of the uterus where the ectopic pregnancy was implanted. The defected scar was resected en bloc with the pregnancy, using the laser. The limits of the resection depended on the residual myometrial thickness. We considered a myometrial thickness of >8 mm as healthy tissue. A metallic probe was introduced vaginally into the endocervix to differentiate the anterior part from the posterior part of the uterus. This probe facilitates the manipulation of the cervix and, thus, the laparoscopic intracorporeal suturing during the myometrial reconstruction. A 2-layered suturing was performed. The first layer of the suture consisted of 3 interrupted figure-of-8 sutures using a monofilament absorbable suture (Monocryl 0, ETHICON-Johnson and Johnson medical devices New Brunswick, New Jersey). A second superficial layer consisted of a continuous nonlocking suture using the same type of thread. MAIN OUTCOME MEASURE(S): Laparoscopic excision of the CSP and immediate repair of the scar defect without any postoperative complications. RESULT(S): An emergent laparoscopy was performed, with excision of the CSP and immediate reconstruction of the residual myometrium. No complications occurred, the blood loss was estimated at 200 mL, and no blood transfusion was necessary. The patient was discharged 24 hours after the intervention. Six months after surgery, the remaining myometrial thickness was between 7 mm and 9.3 mm, and no residual cesarean scar defect (isthmocele) was visualized by ultrasound. CONCLUSION(S): Cesarean scar pregnancy is a rare form of ectopic pregnancy. The incidence, however, is increasing as a consequence of the rising cesarean section rate. Different surgical and nonsurgical techniques have been described in the literature. Laparoscopic excision of a CSP is an effective and feasible technique with the advantage of an immediate myometrial reconstruction. The cesarean scar defect diminishes, and this potentially could improve the future fertility of the patient and decrease the probability of abnormal uterine bleeding and chronic pelvic pain.","[en] ","")
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Karampelas, Stavros ;  Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium. Electronic address: Stavros.karampelas@chu-brugmann.be
Engels, Sara;  Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
Birbarah, Christian;  Department of Obstetrics and Gynecology, Centre Hospitalier Regional de la Citadelle, Liege, Belgium
Nisolle, Michelle ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR) ; Department of Obstetrics and Gynecology, Centre Hospitalier Regional de la Citadelle, Liege, Belgium
Language :
English
Title :
Laparoscopic approach for a cesarean scar pregnancy.
Publication date :
May 2022
Journal title :
Fertility and Sterility
ISSN :
0015-0282
eISSN :
1556-5653
Publisher :
Elsevier Inc., United States
Volume :
117
Issue :
5
Pages :
1099 - 1101
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 18 January 2023

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