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MASTER COURSE: Laparoscopic Resection and Repair for Isthmocele

The Ob. Gyn News’ Master Class in Gynecologic Surgery is hosted by AAGL SurgeryU, and is edited by Dr. Charles E. Miller, a past president of the AAGL, and a long standing faculty member of SurgeryU. This month’s edition of the Master Class covers strategies for transobturator mid-urethral sling placement.

 

Laparoscopic Resection and Repair for Isthmocele

Courtesy of Dr. Kirsten Sasaki – The Advanced Gynecologic Surgery Institute

An isthmocele appears as a fluid-filled pouch-like defect in the anterior uterine wall at the site of a prior cesarean section. A laparoscopic approach utilizing harmonic energy and concomitant hysteroscopy is a treatment of choice. Following incision of the vesico-uterine peritoneum over the anterior uterine wall, the bladder is backfilled and a hysteroscopy is performed to precisely locate the isthmocele. The defect is excised with an ultrasonic curved blade, and the clean edges are sutured together, in an interrupted mattress-style fashion, with a monofilament non-barbed 3-O PDS suture on a CT-1 needle. A second layer is then placed to imbricate over the initial layer of closure 


Filed under "Master Course in Gynecologic Surgery".

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