Roboticky asistované chirurgické riešenie defektu jazvy po cisárskom reze

Download PDF English version

Authors: E. Dosedla; Z. Ballová
Authors‘ workplace: Department of Gynaecology and Obstetrics, Faculty of Medicine, P. J. Šafárik University and Hospital AGEL Košice-Šaca Inc., Košice-Šaca, Slovak Republic
Published in: Ceska Gynekol 2025; 90(4): 339-342
Category:
doi: https://doi.org/10.48095/cccg2025339

Overview

Rastúci celosvetový výskyt cisárskych rezov vedie k výraznému nárastu súvisiacich pôrodníckych a gynekologických komplikácií, najmä defektu jazvy po cisárskom reze. Manažment sa riadi prevažne symptómami, reprodukčnými plánmi a individuálnymi anatomickými faktormi. V literatúre v súčasnosti chýbajú definitívne usmernenia odporúčajúce jednotný optimálny prístup riešenia defektu jazvy po cisárskom reze. Zavedenie robotickej chirurgie prinieslo sľubnú novú operačnú techniku, ktorá sa vyznačuje zvýšenou chirurgickou presnosťou, lepšou vizualizáciou, zníženou morbiditou a rýchlym zotavením pacientky. V konečnom dôsledku predstavuje prijatie roboticky asistovanej chirurgie pri oprave defektu jazvy po cisárskom reze kritický pokrok v gynekologickej chirurgii.

Klíčová slova:

defekt jazvy po cisárskom reze – syndróm jazvy po cisárskom reze – oprava jazvy – roboticky asistovaná oprava jazvy – oprava istmokély

Sources

1. Armstrong F, Mulligan K, Dermott RM et al. Cesarean scar niche: an evolving concern in clinical practice. Int J Gynaecol Obstet 2023; 161 (2): 356–366. doi: 10.1002/ijgo.14509.

2. La Rosa MF, McCarthy S, Richter C et al. Robotic repair of uterine dehiscence. JSLS 2013; 17 (1): 156–160. doi: 10.4293/108680812X13517013317996.

3. Dosedla E, Calda P. Outcomes of laparoscopic treatment in women with cesarean scar syndrome. Med Sci Monit 2017; 23 : 4061–4066. doi: 10.12659/msm.902720.

4. Stavridis K, Balafoutas D, Vlahos N et al. Current surgical treatment of uterine isthmocele: an update of existing literature. Arch Gynecol Obstet 2025; 311 (1): 13–24. doi: 10.1007/s00404 -⁠ 024-07880-w.

5. Gkegkes ID, Psomiadou V, Minis E et al. Robot-assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence. J Robot Surg 2023; 17 (3): 745–751. doi: 10.1007/s11701-022-01502-w.

6. Nirgianakis K, Oehler R, Mueller M. The Rendez-vous technique for treatment of caesarean scar defects: a novel combined endoscopic approach. Surg Endosc 2016; 30 (2): 770–771. doi: 10.1007/s00464-015-4226-6.

7. Stout A, Dicks-Ilori L, Elghobashy A. Isthmocele: a case report and review of an increasingly common gynecological hurdle. Cureus 2024; 16 (10): e71988. doi: 10.7759/cureus.71988.

8. Zhang NN, Wang GW, Zuo N et al. Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection. BMC Pregnancy Childbirth 2021; 21 (1): 815. doi: 10.1186/s12884-021-04281-8.

9. Dominguez JA, Pacheco LA, Moratalla E et al. Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis. Ultrasound Obstet Gynecol 2023; 62 (3): 336–344. doi: 10.1002/uog.26171.

10. Nezhat C, Falik R, Li A. Surgical management of niche, isthmocele, uteroperitoneal fistula, or cesarean scar defect: a critical rebirth in the medical literature. Fertil Steril 2017; 107 (1): 69–71. doi: 10.1016/j.fertnstert.2016.10.017.

11. Wang HF, Chen HH, Ting WH et al. Robotic or laparoscopic treatment of cesarean scar defects or cesarean scar pregnancies with a uterine sound guidance. Taiwan J Obstet Gynecol 2021; 60 (5): 821–826. doi: 10.1016/j.tjog.2021.07.007.

12. Yalcinkaya TM, Akar ME, Kammire LD et al. Robotic-assisted laparoscopic repair of symptomatic cesarean scar defect: a report of two cases. J Reprod Med 2011; 56 (5–6): 265–270.

13. Hofgaard E, Westman K, Brunes M et al. Cesarean scar pregnancy: reproductive outcome after robotic laparoscopic removal with simultaneous repair of the uterine defect. Eur J Obstet Gynecol Reprod Biol 2021; 262 : 40–44. doi: 10.1016/j.ejogrb.2021.05.004.

14. Schmitt A, Crochet P, Agostini A. Robotic--assisted laparoscopic treatment of residual ectopic pregnancy in a previous cesarean section scar: a case report. J Minim Invasive Gynecol 2017; 24 (3): 342–343. doi: 10.1016/j.jmig.2016. 08.815.

15. Cardaillac C, Salmon C, Vaucel E et al. Robot-assisted laparoscopy repair of uterine isthmocele: a two-center observational study. Int J Gynaecol Obstet 2023; 160 (1): 244–248. doi: 10.1002/ijgo.14319.

16. Hoffmann E, Vahanian S, Martinelli VT et al. Combined medical and minimally invasive robotic surgical approach to the treatment and repair of cesarean scar pregnancies. JSLS 2021; 25 (3): e2021.00039. doi: 10.4293/JSLS. 2021.00039.

17. Sinha R, Rupa B, Pentakota A. Improving precision and safety in uterine isthmocele repair by utilizing the KOH Cup and Firefly guidance. Cureus 2025; 17 (3): e79934. doi: 10.7759/cureus.79934.

18. Kulshrestha V, Agarwal N, Kachhawa G. Post-caesarean niche (isthmocele) in uterine scar: an update. J Obstet Gynaecol India 2020; 70 (6): 440–446. doi: 10.1007/s13224-020-01370-0.

19. Nyangoh Timoh K, Enderle I, Leveque J et al. Robotic-assisted laparoscopy using hysteroscopy treatment of a residual cesarean scar pregnancy and isthmocele. Gynecol Obstet Fertil Senol 2020; 48 (5): 460–461. doi: 10.1016/ j.gofs.2020.03.006.

20. Kurup M, Bidarahalli S, Jayaram S. Robotic surgery in gynaecology: a retrospective evaluation of an experience at a single centre. J Obstet Gynaecol India 2024; 74 (1): 53–59. doi: 10.1007/s13224-023-01852-x.

21. Wang P, Su YJ, Jia CY. Current surgical practices of robotic-assisted tissue repair and reconstruction. Chin J Traumatol 2019; 22 (2): 88–92. doi: 10.1016/j.cjtee.2019.01.003.