Laparoscopic Isthmocele Repair

Abstract

Video Objective We review options for diagnosis and management of a symptomatic isthmocele, or cesarean scar defect. We then demonstrate laparoscopic management of an isthmocele with minimal residual myometrium. Setting The patient was a 43 year old G3P1111 with a history of two prior cesarean sections, secondary infertility, and evidence of isthmocele on imaging. The surgery was performed in an ambulatory center affiliated with a tertiary teaching hospital. Interventions We excised and repaired her cesarean scar defect using a combined laparoscopic and hysteroscopic approach. Dilute vasopressin was used for hemostasis, excision was performed with a harmonic scalpel, and the defect was repaired via laparoscopic suturing with intracorporeal knot tying. Conclusion An isthmocele is a cesarean scar defect associated with abnormal bleeding, pain, and infertility. Treatment depends on the thickness of the residual myometrium and the patient's goals. A combined approach may be helpful for patients with minimal residual myometrium.