A Pharus Method for Laparoscopically Locating a Uterine Niche in Cesarean Scar Disorder.

INTRODUCTION

Cesarean scar disorder (CSDi) is a pathological entity involving a myometrial defect at the site of a previous cesarean section, commonly associated with postmenstrual spotting, dysmenorrhea, and secondary infertility. While laparoscopic repair is an established treatment, intraoperative localization of the niche remains challenging.

MATERIALS AND SURGICAL TECHNIQUE: We report a novel application of the Pharus method, which utilizes the full-color IR white-light overlay mode of a commercial imaging platform (ELITE III, Olympus, Tokyo, Japan) to enable real-time visualization of hysteroscopic transillumination as green lights under bright-field conditions. A 32-year-old woman diagnosed with CSDi underwent combined hysteroscopic and laparoscopic niche repair. The margins of the niche were precisely delineated, sharply excised, and the uterine wall was reconstructed in two layers using barbed sutures.

DISCUSSION: This is the first reported use of the Pharus method in the laparoscopic repair of CSDi. The technique enhances intraoperative anatomical guidance without the need for reduced lighting. This method may offer a valuable advancement in laparoscopic repair of CSDi.