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Robot-assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence

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Abstract

We aim to assess the available evidence concerning the robot-assisted repair of cesarean scar defect. A systematic PubMed and Scopus search was conducted. All databases were assessed up to May 23, 2022. Studies reporting data on robot-assisted repair of cesarean scar defect were included in this review. Data of 34 patients are presented. The mean age of the patients was 34.8 years old. The mean number of times a woman has been pregnant (gravidity) was 3.1, while the mean number of parity among the included women was 1.9. The mean number of previous cesarean sections among the included women is 1.8. The commonest symptoms at presentation of cesarean scar defect were vaginal bleeding, dysmenorrhea, abdominal pain, secondary infertility amenorrhea and ectopic cesarean scar pregnancy. The gestational age at time of surgery ranged between 6 and 14 weeks. The mean operative time was 165.2 min, while the reported blood loss during the operation ranged between 0 and 400 ml. Bladder perforation was the only intraoperative complication reported (1 out of 34, 2.9%). No conversion to open was reported. The mean interval between the last cesarean section and the development of cesarean scar defect was 22.8 months. Subsequent pregnancy after robotic assisted repair was reported in 16 out of 34 patients (47.1%). Robot-assisted treatment for cesarean scar defect has acceptable effectiveness and risks. Based on available data, uterus-sparing therapy should be considered in patients with cesarean scar pregnancies or symptomatic cesarean scar defect who wish to preserve their fertility. Finally, the role of a combined robotic and hysteroscopic correction of cesarean scar defect for reducing the blood loss and reducing the following obstetrical complications warrants future research.

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References

  1. Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf. Accessed 23 May 2022

  2. Jauniaux E, Ayres-de-Campos D, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel (2018) FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet 140(3):261–264

    Article  PubMed  Google Scholar 

  3. Timor-Tritsch IE, Monteagudo A (2012) Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 207(1):14–29 (published correction appears in Am J Obstet Gynecol. 2014;210(4):371-4)

    Article  PubMed  Google Scholar 

  4. Bij de Vaate AJ, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HAM et al (2014) Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review. Ultrasound Obstet Gynecol 43(4):372–382

    Article  CAS  PubMed  Google Scholar 

  5. Rotas MA, Haberman S, Levgur M (2006) Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107(6):1373–1381

    Article  PubMed  Google Scholar 

  6. Lee CL, Wang CJ, Chao A, Yen CF, Soong YK (1999) Laparoscopic management of an ectopic pregnancy in a previous caesarean section scar. Hum Reprod 14(5):1234–1236

    Article  CAS  PubMed  Google Scholar 

  7. Hoffmann E, Vahanian S, Martinelli VT, Chavez M, Mesbah M, Nezhat FR (2021) Combined medical and minimally invasive robotic surgical approach to the treatment and repair of cesarean scar pregnancies. JSLS 25(3):e2021.00039

    Article  PubMed  PubMed Central  Google Scholar 

  8. Persson J, Gunnarson G, Lindahl B (2009) Robot-assisted laparoscopic surgery of a 12-week scar pregnancy with temporary occlusion of the uterine blood supply. J Robot Surg 3(1):53–55

    Article  PubMed  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hofgaard E, Westman K, Brunes M, Bossmar T, Persson J (2021) Cesarean scar pregnancy: reproductive outcome after robotic laparoscopic removal with simultaneous repair of the uterine defect. Eur J Obstet Gynecol Reprod Biol 262:40–44

    Article  PubMed  Google Scholar 

  11. Wang HF, Chen HH, Ting WH, Lu HF, Lin HH, Hsiao SM (2021) Robotic or laparoscopic treatment of cesarean scar defects or cesarean scar pregnancies with a uterine sound guidance. Taiwan J Obstet Gynecol 60(5):821–826

    Article  PubMed  Google Scholar 

  12. Guan Z, Liu J, Bardawil E, Guan X (2020) Surgical management of cesarean scar defect: the hysteroscopic-assisted robotic single-site technique. J Minim Invasive Gynecol 27(1):24–25

    Article  PubMed  Google Scholar 

  13. Katebi Kashi P, Dengler KL, Welch EK, DiCarlo-Meacham A, Jackson AA, Rose GS (2021) A stepwise approach to robotic assisted excision of a cesarean scar pregnancy. Obstet Gynecol Sci 64(3):329–331

    Article  PubMed  Google Scholar 

  14. La Rosa MF, McCarthy S, Richter C, Azodi M (2013) Robotic repair of uterine dehiscence. JSLS 17(1):156–160

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mahmoud MS, Nezhat FR (2015) Robotic-assisted laparoscopic repair of a cesarean section scar defect. J Minim Invasive Gynecol 22(7):1135–1136

    Article  PubMed  Google Scholar 

  16. Schmitt A, Crochet P, Agostini A (2017) Robotic-assisted laparoscopic treatment of residual ectopic pregnancy in a previous cesarean section scar: a case report. J Minim Invasive Gynecol 24(3):342–343

    Article  PubMed  Google Scholar 

  17. Siedhoff MT, Schiff LD, Moulder JK, Toubia T, Ivester T (2015) Robotic-assisted laparoscopic removal of cesarean scar ectopic and hysterotomy revision. Am J Obstet Gynecol 212(5):681.e1-681.e6814

    Article  PubMed  Google Scholar 

  18. Yalcinkaya TM, Akar ME, Kammire LD, Johnston-MacAnanny EB, Mertz HL (2011) Robotic-assisted laparoscopic repair of symptomatic cesarean scar defect: a report of two cases. J Reprod Med 56(5–6):265–270

    PubMed  Google Scholar 

  19. Ye M, Zhang Q, Li Z, Gu C, Meng Y (2021) Robotic CSP resection and hysterotomy repair. J Minim Invasive Gynecol 28(5):945–946

    Article  PubMed  Google Scholar 

  20. Yoon R, Sasaki K, Miller CE (2021) Laparoscopic excision of cesarean scar pregnancy with scar revision. J Minim Invasive Gynecol 28(4):746–747

    Article  PubMed  Google Scholar 

  21. He Y, Wu X, Zhu Q, Wu X, Feng L, Wu X et al (2014) Combined laparoscopy and hysteroscopy vs uterine curettage in the uterine artery embolization-based management of cesarean scar pregnancy: a retrospective cohort study. BMC Womens Health 14:116

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maheux-Lacroix S, Li F, Bujold E, Nesbitt-Hawes E, Deans R, Abbott J (2017) Cesarean scar pregnancies: a systematic review of treatment options. J Minim Invasive Gynecol 24(6):915–925

    Article  PubMed  Google Scholar 

  23. Deng J, Li S, Peng Y, Chen Z, Wang C, Fan Z et al (2020) Chinese herbal medicine for previous cesarean scar defect: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 99(50):e23630

    Article  PubMed  Google Scholar 

  24. Donnez O (2020) Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril 113(4):704–716

    Article  PubMed  Google Scholar 

  25. Vitale SG, Ludwin A, Vilos GA, Török P, Tesarik J, Vitagliano A et al (2020) From hysteroscopy to laparoendoscopic surgery: what is the best surgical approach for symptomatic isthmocele? A systematic review and meta-analysis. Arch Gynecol Obstet 301(1):33–52

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, 17C James House, Residential Village, Bovemoors Lane, Exeter, EX2 5DS, UK

    Ioannis D. Gkegkes

  2. Athens Colorectal Laboratory, Athens, Greece

    Ioannis D. Gkegkes

  3. Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece

    Victoria Psomiadou & Christos Iavazzo

  4. Obstetrics, Gynecology and Reproductive Health, Rutgers New Jersey Medical School, Newark, NJ, USA

    Evelyn Minis

Authors
  1. Ioannis D. Gkegkes
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  2. Victoria Psomiadou
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  3. Evelyn Minis
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  4. Christos Iavazzo
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Contributions

All authors made substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data. IDG, VP, EM, CI: participated in conception and design of project. Acquisition of data, as well as analysis and statistical interpretation, were performed by IDG, EM, CI. Drafting of the manuscript and critical revisions were done by all authors. Supervision of the project was performed by IDG and CI.

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Correspondence to Ioannis D. Gkegkes.

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Ioannis D. Gkegkes, Victoria Psomiadou, Evelyn Minis, Christos Iavazzo: no conflict of interest.

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Gkegkes, I.D., Psomiadou, V., Minis, E. et al. Robot-assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence. J Robotic Surg 17, 745–751 (2023). https://doi.org/10.1007/s11701-022-01502-w

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  • DOI: https://doi.org/10.1007/s11701-022-01502-w

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