Robotic-assisted laparoscopic repair of a symptomatic uterine isthmocele following cesarean delivery: a case report.

A uterine isthmocele, or cesarean scar defect, is a complication of cesarean delivery. This report presents a 36-year-old female patient with chronic pelvic pain and uterine bleeding years after a cesarean delivery. Initially, conservative treatment did not alleviate these symptoms. Upon failing conservative measures for symptom relief, she elected to undergo a definitive surgical repair. The patient underwent diagnostic hysteroscopy followed by robotic-assisted laparoscopic repair. Intraoperative evaluation revealed a 2-3 cm niche at the lower uterine segment, which was excised and reconstructed in two layers. Bilateral tubal patency and a watertight closure were confirmed with methylene blue instillation. The procedure was completed without complications and with minimal blood loss. Postoperative recovery was uncomplicated, and the patient reported early symptom improvement. This case demonstrates a minimally invasive surgical technique in a patient with a symptomatic isthmocele and serves to inform osteopathic practitioners of considerations when encountering patients with post-cesarean sequelae.