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Obstetrics and Gynegology2021№10
Robot-assisted correction of incompetent uterine...

Robot-assisted correction of incompetent uterine scar after cesarean section

DOI
https://dx.doi.org/10.18565/aig.2021.10.143-152

Ponomareva Yu.N., Loginova E.A., Sementsova N.A.

1) A.S. Loginov Moscow Clinical Scientific Centre, Moscow Department of Health, Moscow, Russia; 2) A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
Objective: To evaluate the results of a robot-assisted correction of incompetent uterine scar after cesarean section.
Materials and methods: The study included ten patients who were diagnosed with incompetent uterine scar after cesarean section. The average age of the patients was 37.2 (4) years. All patients had prolonged blood discharge after menstruation, namely up to 10–12 days after menstruation, seven patients had dysmenorrhea, three patients had dyspareunia, and two women had chronic pelvic pain. All patients underwent MRI examination and hysteroscopy, which showed a niche in the scar area (depth 6.1 (1.4) mm, width 9 (2.4) mm), thinning of the myometrium (the average thickness of the myometrium was 1.62 (0.49) mm). Pregnancy planning was an indication for uterine scar reconstruction in seven patients and severe clinical symptoms suggested correction in three patients. All patients underwent robot-assisted metroplasty using the Da Vinci surgical system.
Results: The average duration of the operation was 105 (24) minutes. The average hospital stay was 5 (1) days. No complications were noted. After the operation, hormonal contraception was prescribed for 6 months. After 6 months, a control study including MRI and hysteroscopy was performed: no niche was found in the scar area, the average thickness of the myometrium was 9.25 (1.4) mm. There was no recurrence of an incompetent uterine scar. A positive clinical picture was noted in all cases: menometrorrhagia stopped and pain syndrome relieved.
Conclusion: Surgical correction of incompetent uterine scar is indicated for all women planning pregnancy and women with clinical symptoms of a niche in the scar after cesarean section. Performing robot-assisted metroplasty may provide the conditions for the formation of a competent uterine scar.

Keywords

cesarean section
uterine scar
niche
robot-assisted correction of the uterine scar
postmenstrual spotting
Full text (in Russian)

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Received 01.09.2021

Accepted 10.09.2021

About the Authors

Yulia N. Ponomareva, Dr. Med. Sci., Head of the Department of Gynecology, A.S. Loginov MCSC, +7(495)304-30-35, y.ponomareva@mknc.ru,
https://orcid.org/0000-0001-5436-9119, 111123, Russia, Moscow, shosse Entuziastov, 86.
Ekaterina A. Loginova, PhD, Researcher, Department of Gynecology, A.S. Loginov MCSC, +7(495)304-30-35, +7(985)182-28-58, e.loginova@mknc.ru,
https://orcid.org/0000-0002-5061-1227, 111123, Russia, Moscow, shosse Entuziastov, 86.
Nataliya A. Sementsova, PhD, Teaching Assistant, Department of Obstetrics and Gynecology of Medical Faculty, A.I. Yevdokimov Moscow State University of Medicine
and Dentistry, +7(910)444-47-28, sementsovanata@rambler.ru, https://orcid.org/0000-0002-0340-5826, 127473, Russia, Moscow, Delegatskaya str., 20/1.
Corresponding author: Nataliya A. Sementsova, sementsovanata@rambler.ru

Authors’ contributions: Ponomareva Yu.N. – developing the concept and design of the article, editing; Loginova E.A.,
Sementsova N.A. – collecting and processing the material, analyzing the obtained data, writing the text.
Conflicts of interest: Authors declare no conflicts of interest.
Funding: The study was conducted without sponsorship.
Patient Consent for Publication: All patients provided informed consent for the publication of their data and associated images.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal researcher.
For citation: Ponomareva Yu.N., Loginova E.A., Sementsova N.A. Robot-assisted correction of incompetent uterine scar after cesarean section.
Akusherstvo i Ginekologiya / Obstetrics and gynecology. 2021; 10: 143-152 (in Russian)
https://dx.doi.org/10.18565/aig.2021.10.143-152

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