Design: Demonstration of the laparoscopic technique with narrated video footage

Setting: Litotomy position. Supine position

Patients or Participants: Patient who presented hematuria, dysmenorrhea, dyspareunia, abdominal distension and secondary sterility.

Interventions: Laparoscopic treatment is important in women who are sympomatic, have thin endometrium, and desire a pregnancy. Key strategies are:

• Dissection of the vesicouterine pouch laterally to avoid entering the bladder wall
• Transilumination with histeroscopy
• Cut the damage tissue
• Suture

Measurements and Main Results:

An isthmocele is a pouch-like defect in the anterior wall of the uterine isthmus that occurs as a complication of a previous caesarean section. There is no universal definition or standard characterization indicating its location and size. Most authors and experts agree that the depth of the defect should be at least 2 mm.

Although it can be asymptomatic, isthmocele may generate gynecological and obstetric manifestations. It can cause SUA (post-menstrual spotting, heavy and prolonged bleeding, intermenstrual bleeding, and occasionally sinus bleeding), pelvic pain, dysmenorrhea, dyspareunia, and secondary infertility. Obstetric complications are: pregnancy scar and uterine rupture.

The reported prevalence of this pathology varies from 19-84%, its suspicion is of great importance for its correct diagnosis, treatment and improvement of the patient's quality of life.

Conclusion: Surgical treatment of a uterine isthmocele is a good option in women who are symptomatic and infertile. Laparoscopic treatment guide by histeroscopy is a good option if residual myometrium is < 3 mm.