Uterine isthmocele: obstetric outcomes after robotic-assisted laparoscopic repair.

An isthmocele, also called a cesarean scar defect or niche, is a defect in the lower uterine segment myometrium that occurs as a result of a cesarean delivery. This study aims to review our institution’s comprehensive data following robotic-assisted laparoscopic isthmocele repair (RA-IR) including birth outcomes and changes in the dimensions of the isthmocele. This was a retrospective case series at a single high-volume tertiary medical center in the United States with over 2500 gynecologic surgeries performed yearly. All women with an identified isthmocele who underwent RA-IR between 9/2015 and 12/2022 were included. Detailed chart review, imaging review with a pelvic radiologic specialist, and post-operative questionnaire were utilized in our analysis. Our primary outcome was post-operative live births. Secondary outcomes included post-operative fertility rate, radiologic changes, and symptom improvement. Twenty-eight patients underwent RA-IR during the study period. Of the 17 patients who attempted pregnancy, 94.1% were able to conceive status post-repair including 7 patients with a pre-operative diagnosis of primary or secondary infertility. Of these, 12 who continued their pregnancies achieved their goal of a live birth (n = 12 of 15, 80.0%). There were a total of 20 pregnancies post-repair, resulting in 12 live births, 6 miscarriages, 1 cesarean scar pregnancy, and 1 termination, which corresponds to a live birth rate per pregnancy of 60.0% (n = 12 of 20). There was a statistically significant improvement in myometrial depth, width, and residual myometrial thickness postoperatively (p < 0.1). The greatest difference was seen in the depth of the isthmocele. The residual myometrial thickness improved from mean of 0.63 mm before to 5.13 mm after surgery. Twelve patients completed a questionnaire regarding symptoms and obstetric outcomes. Symptom improvement was reported by 100% of patients, with 66.7% experiencing complete resolution. RA-IR results in improved defect width, depth, and residual myometrial thickness with preservation of fertility and good obstetric outcomes with a live birth yield of 80.0%. Similar content being viewed by others Data availability Data are available from the authors upon reasonable request.

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J Minim Invasive Gynecol. 15(2):172–175 Funding No funding was received for the conduction of this study. Author information Authors and Affiliations Contributions Drs Sierra Seaman, Arnold Advincula, and Chetna Arora contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by Dr. Sierra Seaman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest Drs. Advincula and Arora are consultants to Intuitive. Drs. Advincula and Seaman are consultants for Cooper Surgical. Consent to participate Retrospective data use was exempt from consent per the IRB. Informed consent was obtained from all individual participants included in the questionnaire component of the study. Prior presentation This study was presented as an abstract at the 2023 Global Conference for the American Association of Gynecologic Laparoscopists in Nashville, Tennessee. Registration Not applicable. IRB approval This study was approved by the University of Sample IRB on January 13, 2021. Approval number: AAAT5566. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This study was presented as an abstract at the 2023 Global Conference for the American Association of Gynecologic Laparoscopists in Nashville, Tennessee. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Seaman, S.J., Advincula, A.P., Parra, N.S. et al. Uterine isthmocele: obstetric outcomes after robotic-assisted laparoscopic repair. J Robotic Surg 19, 293 (2025). https://doi.org/10.1007/s11701-025-02459-2 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-025-02459-2