Single-incision laparoscopic repair of a cesarean scar defect.

Abstract

OBJECTIVE\nTo evaluate the feasibility of laparoscopic single-incision repair for a cesarean scar defect (CSD).\n\n\nDESIGN\nStep-by-step explanation of surgery using an instructive video, with Institutional Review Board approval.\n\n\nSETTING\nUniversity Hospital, Shandong Province, People s Republic of China.\n\n\nPATIENT(S)\nA 36-year-old G2P1011 woman presented with postmenstrual spotting and pelvic pain that was resistant to medical management. Transvaginal ultrasound revealed a CSD measuring 1.08 × 0.71\xa0cm with a residual myometrial thickness of 1.5\xa0mm. She desired to preserve fertility and had cosmetic concerns related to surgery.\n\n\nINTERVENTION(S)\nWe performed single-incision laparoscopic CSD repair. After abdominal entry, the overlying peritoneum and bladder adhesion were dissected using a monopolar hook, cold scissors, and a grasper. Diagnostic hysteroscopy was performed to identify CSD boundaries. Cold scissors were used to resect the scar tissue, avoiding the use of thermal energy to prevent injury that would impair wound healing. Closure was performed using 2/0 Ethibond suture (Ethicon); the first layer was a running full-thickness vertical suture, and the second layer was a horizontal mattress suture to reduce incisional tension. Single-incision intracorporeal knot tying was successfully accomplished by forming a triangle with the straight laparoscopic forceps and the articulated instrument.\n\n\nMAIN OUTCOME MEASURE(S)\nSuccessful repair of CSD via single-incision laparoscopic surgery.\n\n\nRESULT(S)\nOperative time was 50\xa0minutes; blood loss was 50\xa0mL. At the postoperative visit, the umbilical wound had properly healed with excellent cosmetic results. Abdominal ultrasound demonstrated that the CSD had disappeared. Cyclic menses resumed without postmenstrual spotting or pelvic pain.\n\n\nCONCLUSION(S)\nOur case suggests that single-incision laparoscopic repair is a feasible approach to treat CSD that can provide excellent cosmetic results. Additional studies should investigate the clinical utility of single-incision laparoscopic CSD repair in a larger sample to compare the outcomes with the vaginal and hysteroscopic approaches.