The Kızıldemir VISTA Technique (Vertical Isthmocele Surgical Transvaginal Approach): Prospective Analysis of Anatomic and Reproductive Outcomes of a Novel Vertical Suture Technique.

OBJECTIVE

To evaluate the anatomic, clinical, and reproductive outcomes of the Kızıldemir VISTA (Vertical Isthmocele Surgical Transvaginal Approach), a novel continuous vertical suture technique for transvaginal isthmocele repair, also referred to as cesarean scar defect-related disorder (CSDi).

METHODS

This prospective single-arm pilot study, conducted at a university hospital, enrolled 21 women with symptomatic isthmocele (residual myometrial thickness [RMT] ≤ 3 mm) and secondary infertility or recurrent pregnancy loss. All patients underwent transvaginal repair using a novel continuous vertical (craniocaudal) suture technique. The primary outcome was the change in RMT at 3 months postoperatively. Secondary outcomes included symptom resolution (postmenstrual spotting, pelvic pain) and pregnancy rates at 12-month follow-up.

RESULTS

The mean RMT significantly increased from 1.5 ± 0.5 mm preoperatively to 6.9 ± 1.8 mm postoperatively (p < 0.001). A corresponding significant reduction in niche depth was observed (7.1 ± 1.2 mm to 2.1 ± 1.0 mm; p < 0.001). Symptom resolution was high: postmenstrual spotting resolved in 14/16 patients (87.5%; p = 0.011) and chronic pelvic pain resolved in 6/7 patients (85.7%; p = 0.026). Among 20 patients desiring pregnancy, 14 (70%) conceived (57.1% spontaneous, 42.9% via ART), resulting in 11 live births and 3 ongoing pregnancies. Postoperative RMT was significantly higher in patients who conceived (7.3 ± 1.6 mm) compared to those who did not (5.8 ± 1.2 mm; p = 0.045). No major complications or 12-month recurrences were observed.

CONCLUSION

The novel continuous vertical suture technique for transvaginal isthmocele repair appears to be a promising and feasible approach. Within this pilot cohort, it significantly restored myometrial integrity, effectively resolved associated symptoms, and was associated with favorable pregnancy rates, particularly in patients who achieved greater postoperative myometrial thickness.