<h3>Study Objective</h3> Enhancing the results of laparoscopic metroplasty (LM) in patients with the c-section scar defects. <h3>Design</h3> Level I, Canadian Task Force. A 4-year randomized prospective study evaluating two methods of LM. <h3>Setting</h3> National Center for Obstetrics, Gynecology, and Perinatology, named after V.I. Kulakov, Moscow, Russia. <h3>Patients</h3> The study includes 83 patients of reproductive age (18 – 45 years) with c-section scar defects/niches, who are interested in pregnancy. The first group – 49 patients: LM. The second group – 34 patients: LM with plication of round ligaments and injection of platelet-riched autoplasma (PRP). <h3>Interventions</h3> Standard for both groups laparoscopic metroplasty included hysteroscopic niche exploration and cervical dilation. Laparoscopic exploration of the scar zone; excision of fibrotic tissue using a monopolar hook; myometrial approximation in two layers. The second group also included 5 ml of PRP injection into the myometrial repair zone and plication of the round ligaments. The ultrasound measurement of the scar was carried out before the operation and 6 months following it. <h3>Measurements and Main Results</h3> The original scar thickness in Group 1 was 2.1 (±0.9) mm, and after surgery – 5.0 (±2.4) mm, p = 0.00001; three patients had an unsatisfactory outcome with scar thickness of less than 2.5 mm, which required a repeated operation. In Group 2 the thickness of the scar was originally 2.1 (±0.6) mm before surgery, and 5.6 (±1.3) mm after surgery, p = 0.00001, no unsatisfactory results were noted. When comparing the two methods, a significant difference was found in the increase in the newly formed scar thickness in the second group compared to the first – by 3.9 mm and 2.9 mm, respectively, p = 0.029. <h3>Conclusion</h3> Tissue tension reduction in the area of a newly formed suture on the uterus as well as use of PRP provides for the most favorable conditions for tissue repair after LM.