Isthmocele correction: resectoscopic, laparoscopic or both?

Background: An isthmocele is a myometrial defect in the site of the caesarean scar. In symptomatic women with abnormal uterine bleeding and secondary infertility, surgical correction can be considered. Most authors advocate that when there's a residual myometrium ≥ 3mm it can be corrected through resectoscopic approach and when < 3mm the treatment should be laparoscopic, eventually guided by diagnostic hysteroscopy. Both these techniques have important limitations; therefore, the authors propose combining both techniques, in the same procedure, in order to overcome them.

Objectives: To demonstrate the advantages of a surgical technique for correction of an isthmocele using both resectoscopic and laparoscopic resection.

Material and methods: A stepwise demonstration of the technique with narrated video footage.

Main outcome measures: Intraoperative data and outcomes in the patient's follow-up.

Results: One month after the surgery the patient was asymptomatic, reporting a resolution of the uterine abnormal bleeding, and the ultrasound showed a full correction of the isthmocele.

Conclusion: A combination of resectoscopic and laparoscopic resection, in correcting bigger isthmoceles, is a good option to fully excise all the fibrotic tissue.

Learning objective: This video aims to demonstrate the benefits of using a technique combining resectoscopic and laparoscopic resection for correcting larger isthmoceles.