Seaman Sierra J, Advincula Arnold P, Parra Natalia S, Laifer-Narin Sherelle, Arora Chetna
Department of Gynecologic Specialty Surgery, Columbia University Irving Medical Center-New York Presbyterian Hospital, 622 West 168th St., New York, NY, USA.
Department of Radiology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
J Robot Surg. 2025 Jun 14;19(1):293. doi: 10.1007/s11701-025-02459-2.
An isthmocele, also called a cesarean scar defect or niche, is a defect in the lower uterine segment myometrium that occurs as a result of a cesarean delivery. This study aims to review our institution's comprehensive data following robotic-assisted laparoscopic isthmocele repair (RA-IR) including birth outcomes and changes in the dimensions of the isthmocele. This was a retrospective case series at a single high-volume tertiary medical center in the United States with over 2500 gynecologic surgeries performed yearly. All women with an identified isthmocele who underwent RA-IR between 9/2015 and 12/2022 were included. Detailed chart review, imaging review with a pelvic radiologic specialist, and post-operative questionnaire were utilized in our analysis. Our primary outcome was post-operative live births. Secondary outcomes included post-operative fertility rate, radiologic changes, and symptom improvement. Twenty-eight patients underwent RA-IR during the study period. Of the 17 patients who attempted pregnancy, 94.1% were able to conceive status post-repair including 7 patients with a pre-operative diagnosis of primary or secondary infertility. Of these, 12 who continued their pregnancies achieved their goal of a live birth (n = 12 of 15, 80.0%). There were a total of 20 pregnancies post-repair, resulting in 12 live births, 6 miscarriages, 1 cesarean scar pregnancy, and 1 termination, which corresponds to a live birth rate per pregnancy of 60.0% (n = 12 of 20). There was a statistically significant improvement in myometrial depth, width, and residual myometrial thickness postoperatively (p < 0.1). The greatest difference was seen in the depth of the isthmocele. The residual myometrial thickness improved from mean of 0.63 mm before to 5.13 mm after surgery. Twelve patients completed a questionnaire regarding symptoms and obstetric outcomes. Symptom improvement was reported by 100% of patients, with 66.7% experiencing complete resolution. RA-IR results in improved defect width, depth, and residual myometrial thickness with preservation of fertility and good obstetric outcomes with a live birth yield of 80.0%.
峡部憩室，也称为剖宫产瘢痕缺损或切口憩室，是指剖宫产术后子宫下段肌层出现的缺损。本研究旨在回顾我院在机器人辅助腹腔镜峡部憩室修复术（RA-IR）后的综合数据，包括分娩结局以及峡部憩室尺寸的变化。这是一项在美国一家每年进行超过2500例妇科手术的大型三级医疗中心开展的回顾性病例系列研究。纳入了2015年9月至2022年12月期间所有接受RA-IR治疗的确诊峡部憩室的女性。我们的分析采用了详细的病历审查、与盆腔放射科专家的影像审查以及术后问卷调查。我们的主要结局是术后活产。次要结局包括术后生育率、影像学变化和症状改善。在研究期间，28例患者接受了RA-IR。在17例尝试妊娠的患者中，94.1%在修复后能够受孕，其中包括7例术前诊断为原发性或继发性不孕的患者。其中，12例继续妊娠的患者实现了活产目标（15例中的12例，80.0%）。修复后共有20次妊娠，导致12例活产、6例流产、1例剖宫产瘢痕妊娠和1例终止妊娠，这相当于每次妊娠的活产率为60.0%（20例中的12例）。术后子宫肌层深度、宽度和残余肌层厚度有统计学意义的改善（p<0.1）。峡部憩室深度的差异最为显著。残余肌层厚度从术前的平均0.63mm改善到术后的5.13mm。12例患者完成了关于症状和产科结局的问卷调查。100%的患者报告症状有改善，其中66.7%的患者症状完全缓解。RA-IR可改善缺损宽度、深度和残余肌层厚度，保留生育能力，并取得良好的产科结局，活产率为80.0%。
