Laparoscopic Repair of a Uterine Isthmocele with Hysteroscopic Guidance

Study Objective Describe an approach to a laparoscopic repair of a uterine isthmocele using hysteroscopic guidance. Design N/A Setting The procedure was performed at a large tertiary care center that is also a teaching hospital. The patient was positioned in dorsal lithotomy in stirrups. Three 5mm ports were placed including an umbilical port and a right and left lower quadrant port placed 10mm from the midline above the level of the anterior superior iliac spine. Hysteroscopy was performed to identify the defect. The defect was then trans-illuminated and visualized on laparoscopy to aid in proper resection and repair. Patients or Participants N/A Interventions The paravesical space was opened. A bladder flap was developed to expose the isthmocele in the lower uterine segment. The defect in the myometrium was excised circumferentially. The defect was then closed in three layers. The endometrium was closed with a running 3-0 monocryl suture. The myometrium and serosa were closed with a running unidirectional barbed suture in two layers. The peritoneum overlying the bladder was re-approximated with the unidirectional barbed suture as well. Measurements and Main Results N/A Conclusion Hysteroscopic guidance should be considered as an aid in the laparoscopic approach to repairing symptomatic uterine scar defects.