8 Steps for the Robotic Excision of a Cesarean Scar Ectopic Pregnancy

INTRODUCTION: Cesarean scar ectopic is an early pregnancy complication associated with pregnancy implantation into the scar of a prior cesarean delivery. If left unmanaged, cesarean scar ectopic pregnancies have a nearly 100% risk of progressing to the placenta accreta spectrum and are associated with high maternal morbidity and mortality. Although overall rare, with incidences reported between 1 in 1,800 and 1 in 2,226 pregnancies, early diagnosis and management of these pregnancies is crucial to prevent maternal complications. These ectopic pregnancies can be successfully managed with minimally invasive surgery through the implementation of key techniques to optimize visualization, minimize blood loss, and allow for the complete resection of the ectopic pregnancy with reconstruction of the uterus. By recognizing these surgical steps, gynecologic surgeons can feel comfortable safely managing cesarean scar ectopic pregnancies to improve future maternal and fetal outcomes. OBJECTIVE: The objective of this video is to review the steps for performing a robotic excision of a cesarean scar ectopic pregnancy. The video highlights key anatomic considerations and techniques to minimize blood loss and optimize future fertility. METHODS: The patient is a 39-year-old at 9 weeks of gestation diagnosed with a cesarean scar ectopic pregnancy. The patient underwent a robotic excision of the cesarean scar ectopic pregnancy, reconstruction of the lower uterine segment, and dilatation and curettage at an academic, tertiary care medical center. RESULTS: The patient was discharged home postoperative day 1 and had an uncomplicated recovery. Postoperative imaging showed no residual cesarean scar defect. CONCLUSIONS: This video demonstrates robotic excision of a cesarean scar ectopic pregnancy and uterine reconstruction in eight steps. It reviews techniques to minimize blood loss and improve uterine repair and future fertility success. It also discusses conditions that can complicate cesarean scar pregnancies, including possible molar pregnancies and placenta accreta spectrum disorders. Careful diagnosis, management, and follow-up for patients with cesarean scar pregnancies are vital to reduce maternal and surgical morbidity and mortality, as well as to improve and preserve patients’ future fertility.