Combined medical and minimally invasive robotic surgical approach to the treatment and repair of cesarean scar pregnancies

Eva Hoffmann, Sevan Vahanian, Vanessa T. Martinelli, Martin Chavez, Michael Mesbah, Farr R. Nezhat

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background and Objectives: The rise in cesarean deliv-eries, has led to increase in maternal complications in subsequent pregnancies such as abnormal placental im-plantation, uterine rupture, hemorrhage and, less com-monly, cesarean scar pregnancies (CSP). Our objective was to describe patient characteristics following a combined medical and surgical treatment approach to first trimester cesarean scar pregnancies. Methods: This was a case series approved by the Institutional Review Board of cesarean scar pregnancies over a two-year period at a single academic institution. The study included five patients with diagnosed cesarean scar pregnancies opting for pregnancy termination with the desire for fertility preservation. Medical treatment involved intra-gestational sac injection of lidocaine fol-lowed by systemic injection of methotrexate. At a mini-mum of two months later, surgical resection of cesarean scar pregnancy and repair of the uterus was performed. Results: Median patient age was 36 (range 34 – 42) years, with 4 (3 – 10) prior pregnancies and 2 (1 – 3) prior cesarean deliveries. 40% (2/5) were Hispanic, 20% (1/5) Caucasian, 20% (1/5) African-American, and 20% (1/5) South Asian. After medical intervention, patients waited on average 4.6 ± 2.3 months before surgery. No post-intervention complications or recurrences occurred. Two patients had a subsequent pregnancy. Conclusion: This case series demonstrates an ideal management of cesarean scar pregnancy using combined medical and surgical approach in treating current ectopic pregnancy and repairing the uterine defect successfully without recurrence.

Original languageEnglish
Article numbere2021.00039
JournalJournal of the Society of Laparoendoscopic Surgeons
Issue number3
StatePublished - 1 Jul 2021
Externally publishedYes


  • Cesarean delivery
  • Ectopic pregnancy
  • Pregnancy termination


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