Laparoscopic Management of Placenta Percreta

Ochalski, Melanie E.; Broach, A.; Lee, Ted

doi:10.1016/j.jmig.2009.10.015

Cited by 17 publications

(7 citation statements)

References 4 publications

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“…Transfusion requirements were reduced by seven units of packed red blood cells; however, only one‐third of women were successfully treated with the staged hysterectomy protocol. Recently, delayed hysterectomy has been reported using an entirely laparoscopic approach several weeks or months after the initial cesarean delivery . This minimally invasive approach may improve visualization of tissue planes and thereby improve hemostasis, but long operating times and risk of hemorrhagic complications limit this approach to highly experienced centers.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of placenta accreta: a 10‐year experience

Tan

Jobling

Wallace

et al. 2013

Acta Obstet Gynecol Scand

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Objective. To examine maternal morbidity in primary surgical management of placenta accreta. Design. Retrospective case series. Setting. Quaternary perinatal referral center in Melbourne, Australia. Population. Clinically suspected and histologically confirmed cases of placenta accreta, increta and percreta. Methods. Women were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records. Main outcome measures. Predefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive (NICU) or special care nurseries (SCN), respiratory distress syndrome. Results. Between 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy (p = 0.04). Nearly twothirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products (p = 0.03), sustain renal tract injury (p = 0.003) and require intensive care admission (p = 0.002). Conclusions. A primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center.Abbreviations: NICU, neonatal intensive care unit; SCN, special care nursery.

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Section: Discussionmentioning

confidence: 99%

Surgical management of placenta accreta: a 10‐year experience

Tan

Jobling

Wallace

et al. 2013

Acta Obstet Gynecol Scand

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“…In the systematic review of urinary tract injury rates with PAS disorders, there were no reported unintentional urologic complications in nine cases of delayed hysterectomy; however, this was not statistically significant when compared with immediate management.Intentional cystotomy and partial cystectomy were still required in three of the second surgeries (33% of the cases) 33. While traditionally these second surgeries involve a laparotomy, minimally invasive surgical approaches including robotics have been reported 92,[94][95][96]. This approach requires advanced skills but may have enhanced visualization compared with laparotomy, along with shorter recovery, although surgical times are quite prolonged (up to 286-330 minutes) [92][93][94][95][96].…”

mentioning

confidence: 99%

“…While traditionally these second surgeries involve a laparotomy, minimally invasive surgical approaches including robotics have been reported 92,[94][95][96]. This approach requires advanced skills but may have enhanced visualization compared with laparotomy, along with shorter recovery, although surgical times are quite prolonged (up to 286-330 minutes) [92][93][94][95][96]. These techniques require care in CoE with both advanced surgical programs and the capacity to manage emergent massive obstetric hemorrhage.…”

mentioning

confidence: 99%

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Allen

Jauniaux

Hobson

et al. 2018

Intl J Gynecology & Obste

274

282

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“…For conservative management of placenta accreta, only a few case reports have been published detailing a minimally invasive approach to hysterectomy, with only one case report using robotic technology. 7 8 9 10 11 …”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches

Fay

Norquist

Jolley

et al. 2016

AJP Rep

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Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.

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Laparoscopic Management of Placenta Percreta

Cited by 17 publications

References 4 publications

Surgical management of placenta accreta: a 10‐year experience

Surgical management of placenta accreta: a 10‐year experience

FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management,

Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches

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