Robotically assisted delayed total laparoscopic hysterectomy for placenta percreta☆

BACKGROUND The prevalence of morbidly adherent placenta has dramatically increased in the setting of the rising cesarean rate in the United States. Delayed surgical management of placenta accreta and its variants is emerging as methods that may significantly decrease bleeding and perioperative complications; however, optimal surgical approaches have not yet been determined. In this report, we present a case of robotic-assisted delayed interval hysterectomy in a patient with placenta percreta. METHOD A minimally invasive approach, via a robotic-assisted total laparoscopic hysterectomy, was utilized for a 39-year-old gravida 9 para 3 with placenta percreta with placenta left in situ ten weeks after a tertiary cesarean section. EXPERIENCE The robotic approach provided excellent visualization to facilitate fine planes of dissection, lower than expected estimated blood loss, and faster recover times when compared with conventional surgical approaches traditionally utilized for interval hysterectomies for placenta percreta. CONCLUSION Robotic-assisted hysterectomy may be considered as an alternative to laparotomy for the delayed interval surgical management of morbidly adherent placenta percreta.