Isthmocele: one problem, many faces.

OBJECTIVE

To review the clinical presentation, diagnosis, and management of uterine isthmoceles, as well as to highlight potential variations and complications.

DESIGN

Narrated video of surgical technique with descriptions of key steps. This video article was deemed by the Mayo Clinic Institutional Review Board to not require institutional review board review. The investigators report no conflicts of interest.

SUBJECTS: Patients with isthmoceles desiring future fertility. The patients included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites.

EXPOSURE: Robot-assisted laparoscopy or hysteroscopy.

MAIN OUTCOME MEASURES: Complete surgical repair of isthmoceles via robot-assisted laparoscopy or hysteroscopy as well as management of isthmocele variations and complications.

RESULTS

The presentation and imaging findings of isthmoceles are reviewed. Surgical videos are then used to demonstrate the principles of surgical management of isthmoceles, both laparoscopically and hysteroscopically. Variations and complications of isthmoceles, and their associated surgical management, are also reviewed. Key surgical techniques include the following:

CONCLUSION

Key surgical techniques can be applied to the repair of isthmoceles in typical locations. However, there are unique anatomic and surgical considerations when approaching variations and complications of isthmoceles.