Design: Surgical video article of single patient case.

Setting: Tertiary care center

Patients or Participants: 33-year-old G3P2002 referred from outside hospital for management of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasound. On presentation she was asymptomatic.

Interventions: Patient underwent robotic excision of CSEP and was discharged home on postoperative day one. In this video we present 5 essential steps to simplify the procedure including 1-Development of the bladder flap, 2-Preemptive clamping of the uterine pedicle at the origin, 3-Vasopressin injection, 4-Evacuation of products of conception, 5-Repair of hysterotomy.

Measurements and Main Results: In this case, robotic management effectively treated the patient’s CSEP. The estimated blood loss was 100ml. Post operatively there were no complications, and the patient was discharged on post operative day one. Pathology confirmed products of conception consistent with CSEP. Beta HCG levels dropped appropriately postoperatively from 33,619 to 9,338. Weekly labs trended down to a level of 10 when patient was lost to follow up.

Conclusion: Minimally invasive surgery presents an effective option in managing CSEP, offering a systematic and fertility-sparing approach with a focus on surgical precision and vascular control. Our emphasis lies in providing reproducible steps to guide gynecologic surgeons in optimizing surgical outcomes while managing this condition