Video Objective To describe a technique of robotic-assisted laparoscopic hysterectomy of a second trimester gravid uterus with placenta percreta Setting A step-by-step explanation of the surgery using video (instructive video). Interventions In this video, we describe the surgical approach opted for this patient desiring pregnancy termination and no desire for future fertility. Minimally invasive surgery was recommended considering decreased blood loss, postoperative pain and hospital stay. Also considering her prior surgical history, the laparoscopic approach would offer better visualization for lysis of adhesions. Intraoperatively, the uterus was found to have adhesions anteriorly to the abdominal wall as well as bladder adhesions to the lower uterine segment. Generalized increased vascularity was observed. The blood supply from the utero-ovarian and the uterine vessels were tackled prior to releasing the adhesion of the anterior wall of the uterus to the anterior abdominal wall. The lower uterine segment was adherent to the bladder, thereby the lateral approach was used to enter the paravesicular space to create a bladder flap to mobilize the bladder inferiorly. An End to End (EEA) sizer was used to identify the colpotomy site. The cardinal ligament were coagulated and transected to lateralize the paracervical tissue. The colpotomy was then performed and the specimen was then exteriorized intact vaginally. The vaginal cuff was then closed in a continuous fashion using 0-VLoc. Estimate blood loss was 300mL. Postoperatively, patient was hemodynamically stable, and post-operative labs were found to be within normal limits. Patient was discharged in stable condition on post-operative day one. Conclusion Robot assisted hysterectomy is feasible and superior to open approach in a patient with a second trimester pregnancy complicated by placenta percreta with completion of child bearing.

中文翻译：

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机器人辅助腹腔镜子宫切除术与原位胎盘在妊娠中期

视频 目的 描述机器人辅助腹腔镜子宫切除术的中孕期妊娠子宫切除术，使用视频（指导性视频）逐步解释手术。干预 在本视频中，我们描述了该患者选择的手术方法，该患者希望终止妊娠且不希望将来有生育能力。考虑到减少失血、术后疼痛和住院时间，建议进行微创手术。同时考虑到她既往的手术史，腹腔镜手术可以更好地观察粘连溶解。术中发现子宫前部与腹壁粘连，膀胱与子宫下段粘连。观察到全身血管分布增加。在解除子宫前壁与前腹壁的粘连之前，处理来自子宫卵巢和子宫血管的血液供应。子宫下段附着于膀胱，采用外侧入路进入膀胱旁间隙，形成膀胱瓣，使膀胱向下活动。使用端到端 (EEA) 分级器来识别阴道切开术部位。将主韧带凝固并横切以使宫颈旁组织侧化。然后进行阴道切开术，然后将标本完整地阴道外化。然后使用0-Vloc以连续方式闭合阴道套囊。估计失血量为300mL。术后，患者血流动力学稳定，术后实验室检查均在正常范围内。术后第一天，患者病情稳定出院。结论 机器人辅助子宫切除术治疗中孕期伴胎盘植入并完成生育的患者优于开腹手术。