FIREFLY IMAGING SYSTEM IN ROBOTIC TAILORED EXCISION AND REPAIR OF A CESAREAN SCAR DEFECT. A VIDEO-ILLUSTRATED CASE REPORT

A 28 years old patient without any comorbidities, presented to our Department of Gynecology and Obstetrics, AOU Maggiore della Carità in Novara (Italy), complaining of persistent intermenstrual spotting and secondary infertility. In her previous only pregnancy, delivery was made by cesarean section in an emergency setting. Transvaginal ultrasound showed a grade 3 cesarean scar defect (38.0x5.1x18.3 mm), with a residual anterior myometrium thickness of 3.0 mm in sagittal section and absent myometrium for almost the entire length of the scar. Given the symptoms and the desire for childbearing, after a tailored counselling, surgical repair of the defect was offered. Robotic-assisted laparoscopy and an intraoperative hysteroscopy were performed. Firefly technology allows to correctly identify by trans-illumination the limits of the defect. Then, the isthmocele was completely removed with cold scissors. Myometrial repair was performed with a double-layer interrupted Vicryl 2-0 suture. The total surgical time was 90 minutes, without intraoperative complications. Thirty days after surgery, there was a complete anatomic repair of the isthmocele. We describe the robotic-assisted surgical management of a cesarean scar defect with a video supplement, in support of Firefly imaging system assistance.