Robot-assisted correction of incompetent uterine scar after cesarean section


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Abstract

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.

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About the authors

Yulia N. Ponomareva

A.S. Loginov Moscow Clinical Scientific Centre, Moscow Department of Health

Email: y.ponomareva@mknc.ru
Dr. Med. Sci., Head of the Department of Gynecology

Ekaterina A. Loginova

A.S. Loginov Moscow Clinical Scientific Centre, Moscow Department of Health

Email: e.loginova@mknc.ru
PhD, Researcher, Department of Gynecology

Nataliya A. Sementsova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia

Email: sementsovanata@rambler.ru
PhD, Teaching Assistant, Department of Obstetrics and Gynecology of Medical Faculty

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