Isthmocele repair: a combined hysteroscopic and laparoscopic approach

Abstract

The objective of this video will be to review the definition, modalities of diagnosis, symptoms, and treatment options of a uterine isthmocele. A step-by-step combined laparoscopic and hysteroscopic isthmocele repair technique will be reviewed. During this 7-minute video we will review the basics of isthmocele including definition, imaging diagnosis, patient symptoms, and treatment options. We will define the residual myometrial thickness (RMT), which assist in deciding the appropriate treatment modality. We will then focus on a 6-step surgical video tutorial of a combined laparoscopic and hysteroscopic isthomocele repair technique. The presentation will end with concluding remarks. Isthomoceles are wedge shape defects with depths greater than 2mm typically found at the previous cesarean hysterotomy site. They are usually asymptomatic and may not require treatment. However, symptoms and/or infertility may prompt a procedural intervention. A laparoscopic repair approach should be considered when the residual myometrial thickness is less than 3mm. A combined laparoscopic and hysteroscopic approach may be beneficial to further define the extent and bounds of damaged tissue.