Transvaginal uterine niche repair: surgical technique and outcome.

Background: A uterine niche after caesarean section may play a role in secondary infertility. The transvaginal approach is a newly developed minimally invasive surgical technique for repairing a uterine isthmocele.

Objectives: To report on the feasibility, effectiveness, and safety of the transvaginal uterine niche repair. The technique is demonstrated in a live-surgery video.

Materials and methods: A retrospective chart review involving all patients with secondary infertility who underwent a transvaginal uterine niche repair in Ziekenhuis Oost-Limburg between August 2019 and July 2022 was conducted.

Main outcome measures: We compared the pre- and postoperative residual myometrial thickness as a primary surgical outcome measurement. The pregnancy ratio and the peri- and postoperative complications were also reported.

Results: A total of 26 patients underwent a transvaginal uterine niche repair with an average operation time of 44 minutes. No major surgical complications were reported. 23 patients (88%) had good postoperative myometrial integrity, while 3 patients had a partial or complete postoperative recurrence of the uterine niche. The average pre- and postoperative myometrial thicknesses were 1.6 mm and 6.4 mm respectively. 64% of patients desiring pregnancy became pregnant after the transvaginal niche repair. There were no obstetric complications reported.

Conclusions: A transvaginal approach is a safe and effective technique for uterine niche repair. It offers good results in re-establishing myometrial integrity and may favour fertility outcomes. It represents a valid minimal invasive procedure for patients with a very thin residual myometrial thickness and secondary infertility without leaving a visual scar.