VIDEO Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 242-243

Laparoscopic operation under hysteroscopic guidance in management of cesarean scar defect

Hoang The Dinh1, An Nguyen Phuong Tran2
1 Department of Obstretric and Gynecology, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
2 Department of Obstretric and Gynecology, Tam Anh Hospital, Ho Chi Minh City, Vietnam

Date of Submission08-Sep-2021Date of Decision05-May-2022Date of Acceptance05-May-2022Date of Web Publication7-Nov-2022

Correspondence Address:
Dr. Hoang The Dinh
School of Medicine, Vietnam National University, Ho Chi Minh City
Vietnam

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/gmit.gmit_113_21

How to cite this article:
Dinh HT, Phuong Tran AN. Laparoscopic operation under hysteroscopic guidance in management of cesarean scar defect. Gynecol Minim Invasive Ther 2022;11:242-3
How to cite this URL:
Dinh HT, Phuong Tran AN. Laparoscopic operation under hysteroscopic guidance in management of cesarean scar defect. Gynecol Minim Invasive Ther [serial online] 2022 [cited 2022 Nov 8];11:242-3. Available from: https://www.e-gmit.com/text.asp?2022/11/4/242/360526   Objective 

To demonstrate how to optimally combine laparoscopy and hysteroscopy in isthmocele repair.

  Design 

Step-by-step illustration of the technique with a narrated high-resolution video.

  Setting 

The progressive increase in the rate of cesarean sections has led to rapid growth in the proportion of cesarean scar defect (CSD) recently, which creates an enormous burden for the healthcare systems in the world.[1] In this case, the patient she is a 35-year-old woman, G1P1 with postmenstrual bleeding and secondary infertility (repeated embryo transfer failure) which are caused by large CSD.

  Interventions 

The combination of laparoscopy and hysteroscopic guidance with several key strategies to optimize isthmoplasty involves following steps:[1],[2],[3],[4]

Identification of isthmocele throughout hysteroscopyMeticulous dissection uterovesical adhesion and bladder is pushed down at least 2 cm apart from the inferior edge of CSDUtility of “Halloween sign” to determine frontier of CSD by hysteroscopic guidanceCold scissor resection of all scar tissue until marginally rich blood supply boundary improves vascularization in the healing processRe-approximation of low segment cesarean scar with two-layer myometrial suture under uterine manipulator supportClosure of uterovesical fold combined with shortening round ligaments aims to prevent recurrent CSD and intra-abdominal adhesion [Figure 1]Re-examination the continuity of anterior uterine wall guarantees the efficacy of the operation.

Endoscopic operation ended without any complications and within 90 min at a private hospital. Then, the patient was discharged 3 days later, and the embryo transfer was performed 6 months after surgery. At the moment, she is pregnant at 16 weeks of gestation.

  Conclusion 

Laparoscopic operation under hysteroscopic illumination in managing CSD is safely effective in skillful surgeons.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Donnez O. Cesarean scar defects: Management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril 2020;113:704-16.  
    2.Török P. Surgical therapeutic options for previous cesarean scar defect in women with postmenstrual bleeding. J Invest Surg 2021;34:1156-7.  
    3.Vervoort A, Vissers J, Hehenkamp W, Brölmann H, Huirne J. The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: A prospective cohort study. BJOG 2018;125:317-25.  
    4.Vigueras Smith A, Cabrera R, Zomer MT, Ribeiro R, Talledo R, Kondo W. Combined laparoscopic-hysteroscopic isthmoplasty using the rendez-vous technique guided step by step. J Minim Invasive Gynecol 2020;27:1469-70.  
    
  [Figure 1]