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Robotic-assisted laparoscopic cervicouterine anastomosis in a patient with agenesis of the uterine isthmus
Fertility and Sterility ( IF 6.7 ) Pub Date : 2021-11-19 , DOI: 10.1016/j.fertnstert.2021.10.001
Marco Iraci Sareri 1 , Giulia M Bonanno 1 , Giuseppe Sarpietro 1 , Antonio Cianci 1
Affiliation  

Objective

To demonstrate the surgical management of agenesis of the uterine isthmus.

Design

Stepwise description of robotic-assisted laparoscopic cervicouterine anastomosis.

Setting

Academic medical center.

Patient(s)

A 27-year-old nulligravida with primary amenorrhea and cyclic pelvic pain.

Intervention(s)

The patient underwent a robot-assisted cervicouterine anastomosis using the following surgical steps: adhesiolysis of the right ovary from the rudimentary uterine horn; vesicouterine peritoneal fold dissection and mobilization of the cervical canal; the opening of the cervical canal and dilatation with Hegar dilators; longitudinal incision of the lower third of the anterior uterine wall up to the endometrial cavity; insertion of a 14 Ch Foley catheter, not inflated, fixed to the cervix with a suture and removed after 7 days; and closure of the cervicouterine breach with a double-layer Vicryl suture. Informed consent was obtained from the patient for the use of video and images.

Main outcome measure(s)

After 3 months, the patency of the anastomosis site was assessed via hysteroscopy. Subsequent follow-up was performed by referring physicians.

Result(s)

Postoperatively, anatomic continuity was restored and the patient was menstruating with regular monthly cycles; furthermore, cyclic pelvic pain was relieved. Few cases of this condition have been reported in the literature and, currently, surgical treatment of agenesis of the uterine isthmus is controversial, with some treatments including laparoscopic-assisted uterocervical anastomosis using a stent to prevent restenosis, primary cervicouterine anastomosis by laparotomy performed with a Foley catheter in the cervical canal, and anastomosis of the uterine isthmus agenesis. However, to our knowledge, we are the first to use a robotic approach. Preservation of reproductive function and symptom relief represent the goals of the surgery. Therefore, hysterectomy cannot be considered as a treatment option. However, after a cervicouterine anastomosis procedure, the normal uterine morphology cannot be achieved; cyclic abdominal pain may remain after surgical treatment. In this case, an alternative surgical approach, such as hysterectomy, can be considered.

Conclusion(s)

Robotic-assisted treatment of this uncommon müllerian anomaly is feasible and may be an alternative to hysterectomy in individuals who wish to preserve fertility. Follow-up is needed to evaluate fertility and reproductive function.



中文翻译:

机器人辅助腹腔镜宫颈吻合术治疗子宫峡部发育不全患者

客观的

演示子宫峡部发育不全的手术治疗。

设计

机器人辅助腹腔镜宫颈吻合术的逐步描述。

环境

学术医疗中心。

耐心)

一名 27 岁的初产妇,患有原发性闭经和周期性盆腔痛。

干预措施

患者接受了机器人辅助的宫颈吻合术,手术步骤如下:从原始子宫角粘连右卵巢;膀胱子宫腹膜皱襞解剖和宫颈管动员;用 Hegar 扩张器打开宫颈管并扩张;子宫前壁下三分之一的纵向切口直至子宫内膜腔;插入未充气的 14 Ch Foley 导管,用缝合线固定在宫颈上,7 天后取出;并用双层 Vicryl 缝合线缝合宫颈口裂口。获得患者使用视频和图像的知情同意。

主要观察指标)

3个月后,通过宫腔镜检查吻合口的通畅情况。随后由转诊医生进行随访。

结果)

术后,解剖学连续性恢复,患者月经周期规律;此外,周期性骨盆疼痛得到缓解。文献报道了这种情况的少数病例,目前,子宫峡部发育不全的手术治疗存在争议,一些治疗方法包括腹腔镜辅助子宫颈吻合术,使用支架预防再狭窄,通过剖腹手术进行原发性宫颈吻合术。 Foley导管在宫颈管中,与子宫峡部发育不全吻合。然而,据我们所知,我们是第一个使用机器人方法的人。保留生殖功能和缓解症状代表了手术的目标。因此,不能将子宫切除术视为一种治疗选择。然而,宫颈吻合术后,不能达到正常的子宫形态;手术治疗后可能会出现周期性腹痛。在这种情况下,可以考虑另一种手术方法,例如子宫切除术。

结论

这种不常见的苗勒管异常的机器人辅助治疗是可行的,并且可能是希望保留生育能力的个体的子宫切除术的替代方法。需要随访以评估生育能力和生殖功能。

更新日期:2021-11-19
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