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

Laparoscopic operation under hysteroscopic guidance in management of cesarean scar defect


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

Correspondence Address:
Dr. Hoang The Dinh
School of Medicine, Vietnam National University, Ho Chi Minh City
Vietnam
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gmit.gmit_113_21

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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 Dec 8];11:242-3. Available from: https://www.e-gmit.com/text.asp?2022/11/4/242/360526




  Objective Top


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


  Design Top


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


  Setting Top


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 Top


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

  1. Identification of isthmocele throughout hysteroscopy
  2. Meticulous dissection uterovesical adhesion and bladder is pushed down at least 2 cm apart from the inferior edge of CSD
  3. Utility of “Halloween sign” to determine frontier of CSD by hysteroscopic guidance
  4. Cold scissor resection of all scar tissue until marginally rich blood supply boundary improves vascularization in the healing process
  5. Re-approximation of low segment cesarean scar with two-layer myometrial suture under uterine manipulator support
  6. Closure of uterovesical fold combined with shortening round ligaments aims to prevent recurrent CSD and intra-abdominal adhesion [Figure 1]
  7. Re-examination the continuity of anterior uterine wall guarantees the efficacy of the operation.
Figure 1: Closure of uterine myometrium and uterovesical fold following by shortening round ligaments.
http://www.apagemit.com/page/video/show.aspx?num=277


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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 Top


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 Top

1.
Donnez O. Cesarean scar defects: Management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril 2020;113:704-16.  Back to cited text no. 1
    
2.
Török P. Surgical therapeutic options for previous cesarean scar defect in women with postmenstrual bleeding. J Invest Surg 2021;34:1156-7.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

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