#197 Robotic-Assisted Laparoscopic Isthmocele Repair with Firefly Guidance- Drs.Seaman & Advincula

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Title: Robotic-Assisted Laparoscopic Isthmocele Repair with Firefly Guidance Surgeons: Sierra J. Seaman, MD; Arnold P. Advincula, MD Institution: Columbia University Irving Medical, New York, NY, USA

Objective: In this video, we illustrate the key surgical steps of robotic-assisted laparoscopic isthmocele repair (RA-IR) with simultaneous hysteroscopy and Firefly guidance. We also share our institution’s comprehensive data following RA-IR inclusive of fertility and obstetric outcomes and changes in radiologic dimensions of the isthmocele.

Interventions: The case presented is a 44-year-old G5P3023 with infertility and postmestrual spotting in the setting of an isthmocele. Key surgical steps of RA-IR include:

1. Pre-surgical planning with MRI

2. Meticulous lysis of vesicouterine adhesions

3. Diagnostic hysteroscopy for confirmation of isthmocele

4. Simultaneous laparoscopy with Firefly guidance for identification of borders

5. Strategic hysterotomy

6. Excision of scar tissue

7. Tension-free closure

Measurements and Main Results: In this retrospective case review, our primary outcome was postoperative live births. Secondary outcomes included fertility rate, symptom improvement, and postoperative change in myometrial depth, width, and residual myometrial thickness. Of the 13 patients who attempted pregnancy, 100% were able to conceive status post repair. To date, 53.84% of patients who attempted conception after repair have had live births and two are currently pregnant without complication. There was a statistically significant improvement in all three measurements on postoperative MRI (p less than 0.1). The residual myometrial thickness increased by an average of 5.13mm (SD 3.58).

Conclusion: RA-IR with simultaneous hysteroscopy and Firefly guidance is safe and effective and results in improved defect measurements with preservation of fertility and good obstetric outcomes.

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