To demonstrate techniques of identifying new anatomical landmarks during uterine niche repair.

Stepwise demonstration with narrated video footage (Canadian Task Force classification III).

Advanced Minimally Invasive Gynaecological Surgery Unit, Campbelltown-Liverpool Hospital.

A 36-year-old, para 1 presented with secondary infertility 3 years post caesarean section performed for dystocia. Fertility investigations revealed mild endometriosis with a caesarean scar niche with residual myometrial thickness of 4 mm identified with saline infusion sonography. She initially underwent 3 IVF cycles without success. After counselling, she was offered caesarean scar niche repair using a combination of laparoscopic and hysteroscopic approach. The limits of the niche can be identified by the “Halloween sign” which involves a combined hysteroscopic and laparoscopic approach. Another method to identify the extent of the caesarean scar niche are “lateral bands” of the uterine niche found at laparoscopy, first described by Dr. Sandesh Kade from India. The video below demonstrates methods of identifying the lateral bands, the “Halloween sign” and repair of the caesarean scar niche.