A novel technique of robotic excision of caesarean scar ectopic pregnancy with near-infrared guidance using the da Vinci Xi system

ABSTRACT: Surgical management of caesarean scar ectopic pregnancy (CSEP) can cause severe bleeding and bladder injury, especially when the vesicouterine plane is scarred with minimal residual myometrium. A 36-year-old multigravida presented at 5 weeks 3 days period of gestation with vaginal bleeding. Beta-human chorionic gonadotropin (β-hCG) level was 23,190 mIU/mL. Imaging confirmed CSEP in the lower uterine segment with residual myometrial thickness of 1 mm. We performed a robotic-assisted excision of CSEP with Firefly technology for delineation of bladder margins, hence improving procedure safety and outcome. Following bladder mobilisation and hysterotomy, products of conception were excised and the uterine defect repaired. Estimated blood loss was 75 mL with no intraoperative complications and preserved bladder integrity. Post-operative recovery was uneventful, and β-hCG was negative by 3 months. Robotic excision with firefly guidance can enhance the identification of vesicouterine interface and facilitate safe bladder dissection.