Hysteroscopic repair of cesarean scar isthmocele

This video highlights a stepwise approach to the hysteroscopic repair of cesarean scar isthmocele. It also discusses patient selection, anatomy, possible association with infertility, and outcomes de- scribed in the literature.

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Volume 110, Issue 3, Pages 555–556

Authors:

Ari P. Sanders, M.D., Ally Murji, M.D., M.P.H.

Abstract:

Objective

To demonstrate an approach to the hysteroscopic repair of cesarean scar isthmocele and discuss its association with secondary infertility.

Design

A step-by-step explanation of the procedure with surgical video footage.

Setting

Academic medical center.

Patient(s)

Two patients undergoing hysteroscopic repair of symptomatic cesarean scar isthmoceles. Surgical candidates for this procedure include patients with a symptomatic isthmocele and a residual myometrial thickness of at least 3 mm confirmed with pre-operative imaging.

Intervention(s)

Operative hysteroscopy is performed using a step-wise approach: identification of relevant anatomy; resection of the cephalad edge of fibrosis; resection of the caudad edge of fibrosis; and ablation of the isthmocele base.

Main Outcome Measure(s)

Restoration of the contour between the uterine cavity and cervical canal.

Result(s)

Hysteroscopic resection of cesarean scar isthmocele is successfully performed in both cases presented. Postoperatively, both patients had resolution of their symptoms.

Conclusion(s)

The surgical approach presented in this video can result in the successful revision of a cesarean scar isthmocele. Current literature supports a role for hysteroscopic isthmoplasty in treating isthmocele-related abnormal uterine bleeding. However, more evidence is required on the safety of conceiving following hysteroscopic isthmoplasty, and its use in the setting of secondary infertility.


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Fertility and Sterility

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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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