Design: A case study with preoperative images, surgical video, and postoperative follow-up is reviewed.

Setting: Care took place in the operating room at a tertiary care center in the Bronx, New York. The patient was positioned in dorsal lithotomy.

Patients or Participants: The patient is a 44-year-old G6P4024 who presented for heavy menstrual bleeding and pelvic pain. Surgical history was relevant for four prior cesarean sections. Transvaginal ultrasound demonstrated uterine myomas and a 5.8 mm deep isthmocele with 3.6 mm residual myometrial thickness at its base.

Interventions: Hysteroscopic isthmocele revision was performed by resection of the inferior edge and ablation of the isthmocele base before concomitant resectoscopic myomectomy and endometrial ablation.

Measurements and Main Results: Time required for hysteroscopic revision was 13 minutes. There were no complications, and the patient was discharged the same day. Three weeks postoperatively, she reported improvement in bleeding and pelvic pain.

Conclusion: This case highlights that isthmoceles - highly prevalent and frequently symptomatic - can be revised with a relatively simple minimally invasive hysteroscopic approach and is associated with few complications.