⚙
AI-generated deep summary
by claude@2026-06, 2026-06-08
· read from full text
ⓘ
This paper describes a feasible laparoscopic procedure for repairing a cesarean scar defect, reporting feasibility aspects rather than presenting a detailed patient outcome dataset in the provided text. It is positioned within the broader literature on “niche”/isthmocele management and cites prior series and case reports of laparoscopic repair approaches. A key limitation stated or implied by the available excerpt is that the full study results and scope (e.g., number of participants, outcomes, and caveats) are not included here, so the evidence basis cannot be assessed from the excerpt alone. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.
Abstract
In 1995, Morris first described cesarean scar defect as an "isthmocele" by macroscopy following hysterectomy in women with prior cesarean delivery. Cesarean scar defect is associated with gynecological symptoms such as abnormal uterine bleeding, secondary infertility, pelvic pain, and obstetrical complications such as cesarean scar pregnancy, placenta accreta, and uterine rupture. Surgical treatment techniques include hysteroscopic resection, transabdominal repair (laparotomy, laparoscopic, and robotic), and vaginal repair. If the residual myometrial thickness is <3 mm and a patient is symptomatic, consideration is made for defect repair from above rather than hysteroscopic resection. The advantages of laparoscopic repair include anatomic restoration of myometrial thickness, correction of uterine retroflexion, exploration of other causes of infertility and pelvic pain, and pathological diagnosis of scar tissue with endometriosis. Cesarean scar defect often cannot be visualized on the side of the abdominal cavity; therefore, it is difficult to identify the extent of the defect laparoscopically. Herein, we introduce laparoscopic cesarean scar defect repair through a surgical video with narration. This technique uses a uterine manipulator to distend and help delineate the defect, and a laparoscopic support suture within the defect as a "handle" to place the scar tissue on tension to ensure complete resection of the fibrotic tissue. Temporary uterine artery occlusion can be included to reduce bleeding in the surgical field to support visualization for complete fibrotic tissue removal and to achieve good apposition with a double-layer suture to promote proper anatomic wound healing. Symptom relief was achieved, and the patient became pregnant one year postoperatively. This video demonstrated a feasible, safe, effective procedure for laparoscopic cesarean scar defect repair in the patient.
Full text
1,918 characters
· extracted from
oa-html
· click to expand
A feasible procedure for laparoscopic cesarean scar defect repair
Affiliations & Notes
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
Article Info
Publication History:
Received November 10, 2023; Revised August 29, 2024; Accepted October 3, 2024; Published online October 9, 2024
Footnotes:
The authors report no conflict of interest.
DOI: 10.1016/j.ajog.2024.10.003 External LinkAlso available on ScienceDirect External Link
Copyright: © 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Linked Articles
Download started
OkVideo
Key words
References
1.
Donnez, O.
Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased
Fertil Steril. 2020; 113:704-716
2.
Nezhat, C. ∙ Falik, R. ∙ Li, A.
Surgical management of niche, isthmocele, uteroperitoneal fistula, or cesarean scar defect: a critical rebirth in the medical literature
Fertil Steril. 2017; 107:69-71
3.
Donnez, O. ∙ Donnez, J. ∙ Orellana, R. ...
Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women
Fertil Steril. 2017; 107:289-296.e2
4.
Donnez, O. ∙ Jadoul, P. ∙ Squifflet, J. ...
Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section
Fertil Steril. 2008; 89:974-980
5.
Api, M. ∙ Boza, A. ∙ Gorgen, H. ...
Should cesarean scar defect be treated laparoscopically? A case report and review of the literature
J Minim Invasive Gynecol. 2015; 22:1145-1152
6.
Jacobson, M.T. ∙ Osias, J. ∙ Velasco, A. ...
Laparoscopic repair of a uteroperitoneal fistula
J Soc Laparoendosc Surg. 2003; 7:367-369
7.
Aust, T. ∙ Reyftmann, L. ∙ Rosen, D. ...
Anterior approach to laparoscopic uterine artery ligation
J Minim Invasive Gynecol. 2011; 18:792-795
Article metrics
Video 1
Video 1
Text is read by the "Ask this paper" AI Q&A widget below.
Extraction quality varies by source — PMC NXML preserves structure
cleanly, OA-HTML may include some navigation residue, and OA-PDF can
have broken hyphenation. The publisher copy
(via DOI)
is the canonical version.