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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 re...

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Detalles Bibliográficos
Autores principales: Smet, C, Nogueira, B, Vilarinho, D, Rodrigues, I, Reis, J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Universa Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643012/
https://www.ncbi.nlm.nih.gov/pubmed/37742206
http://dx.doi.org/10.52054/FVVO.15.3.086
Descripción
Sumario: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. MATERIALS 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.