Robot-assisted metroplasty
The rate of surgical delivery, such as caesarean section, has substantially increased globally in recent decades. One of the adverse consequences of caesarean section is the formation of an inconsistent uterine scar that can become a cause of uterine rupture during pregnancy and childbirth or that of menstrual irregularities and pain syndrome. The excision of scar tissue and the formation of a new scar are an effective treatment for inconsistent uterine scar in patients when planning pregnancy and in the presence of clinical symptoms.Loginova E.A., Ponomareva Yu.N., Davydova I.Yu., Ivanova L.B., Valiev R.K.
The paper presents a literature review on possible methods for surgical correction of uterine scar. It also describes a rare clinical case of reconstructive plastic surgery for inconsistent uterine scar in a patient with complete uterine duplication. A 36-year-old female patient was diagnosed having a scar myometrial thickness of up to 2.5 mm and a niche measuring 10*8 mm in the left uterine body. Hysteroscopic coagulation of a uterine wall defect produced no expected positive effect; the woman still complained of her long-term disrupting quality of life and postmenstrual bleeding. The patient underwent reconstructive plastic surgery, namely, excision ofpathologically altered tissues in the isthmus of the left uterine body to form a new scar using the da Vinci robotic surgery system. Robotic metroplasty yielded positive results: there was no niche in the scar area; the myometrial thickness was 9.3 mm; prolonged postmenstrual bleeding was stopped.
Conclusion: Thus, in our observation, robot-assisted metroplasty could create conditions for the formation of an adequate uterine scar, improve quality of life in a woman and reduce the risk of life-threatening complications of pregnancy and childbirth, such as uterine scar rupture, placental growing into the scar, and maternal and intranatal mortality.
Keywords
caesarean section
niche
postmenstrual bleeding
complete uterine duplication
robotic correction of uterine scar
uterine scar
References
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Received 28.01.2022
Accepted 24.02.2022
About the Authors
Ekaterina A. Loginova, PhD, Researcher at the Laboratory of Gynecology, Department of Pelvic Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, +7(495)304-30-35, +7(985)182-28-58, e.loginova@mknc.ru, https://orcid.org/0000-0002-5061-1227, 111123, Russia, Moscow, Entuziastov Highway, 86.Julia N. Ponomareva, Dr. Med. Sci., Head of the Department of Operative Gynecology and Robotic Surgery, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, y.ponomareva@mknc.ru, https://orcid.org/0000-0001-5436-9119, 117997, Moscow, Russia, Ac. Oparina str., 4.
Irina Yu. Davydova, Dr. Med. Sci., Leading Researcher, Department of Pelvic Floor Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center,
Moscow Healthcare Department, +7(495)304-30-35, i.davydova@mknc.ru, 111123, Russia, Moscow, Entuziastov Highway, 86.
Larisa B. Ivanova, PhD, Head of the Laboratory of Gynecology, Pelvic Oncology Department, A.S. Loginov Moscow Clinical Scientific and Practical Center,
Moscow Healthcare Department, +7(495)304-30-35, l.ivanova@mknc.ru, 111123, Russia, Moscow, Entuziastov Highway, 86.
Ramiz K. Valiev, PhD, Head of the Department of Pelvic Floor Oncology, A.S. Loginov Moscow Clinical Scientific and Practical Center, Moscow Healthcare Department, +7(495)304-30-35, r.valiev@mknc.ru, 111123, Russia, Moscow, Entuziastov Highway, 86.
Corresponding author: Ekaterina A. Loginova, e.loginova@mknc.ru
Authors’ contributions: Loginova E.A., Davydova I.Yu., Ivanova L.B. - concept and design of the article, material collection and processing, text writing and design; Ponomareva Yu.N., Loginova E.A., Ivanova L.B. - material collection; Davydova I.Yu., Valiev R.K., Ivanova L.B. - editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Loginova E.A., Ponomareva Yu.N., Davydova I.Yu., Ivanova L.B., Valiev R.K. Robot-assisted metroplasty.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 3: 129-137 (in Russian)
https://dx.doi.org/10.18565/aig.2022.3.129-137
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