Department of Obstetrics and Gynecology, Lund University Hospital, 221 85, Lund, Sweden.
J Robot Surg. 2009 Mar;3(1):53-5. doi: 10.1007/s11701-009-0135-9. Epub 2009 Feb 27.
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.
剖宫产瘢痕妊娠是一种严重的产科并发症。对于所有的治疗方法，都存在大量出血和紧急子宫切除术的风险。在这里，我们报告使用达芬奇机器人切除妊娠组织，同时能有效控制出血。一位 36 岁的经产妇，诊断为 11+3 周的活剖宫产瘢痕妊娠和完全性前置胎盘。hCG 为 52726IU/L。甲氨蝶呤治疗 1 周后，通过机器人辅助腹腔镜手术顺利且完全切除妊娠组织，术中出血量少。子宫缺陷得到修复。通过临时应用金属夹夹闭子宫远端髂内动脉和固有韧带来控制出血。术后彩色多普勒超声显示子宫血流正常，子宫缺陷得到修复，无妊娠组织残留。术后 38 天 hCG 恢复正常（<3IU/L）。对于剖宫产瘢痕妊娠的手术，机器人辅助腹腔镜手术联合暂时性子宫主要血供阻断是一种可行且安全的技术。
