Abstract

Video Objective The objective of this video is to review the definition, diagnosis, consequences of an uterine isthmocele. This video also demonstrates surgical management of isthmoceles using a combination of laparoscopy and hysteroscopy. Setting A patient with a history of 2 prior cesarean deliveries with strong desire for future fertility was found to have a profound isthmocele on transvaginal ultrasound. She presented for surgical management at our large academic center with a robust minimally invasive gynecological surgical team. Interventions The patient underwent an uncomplicated laparoscopic isthmocele repair. Hysteroscopy was performed concurrently as a means of visualizing the borders of the uterine defect as well as determining adequate margins for full removal. 6 months after repair, the patient underwent a repeat ultrasound that showed an intact repair with normal myometrial thickness. Conclusion Isthmocele is an iatrogenic defect in the uterine myometrium and can complicate future pregnancies. Laparoscopic repair with hysteroscopic guidance is a safe and effective way of addressing an isthmocele for patients that desire future pregnancies.

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