Design: A case report

Setting: Pandit Hospital and Laparoscopy Centre, Ahmednagar, India

Patients or Participants: A 26-year-old female with a history of two Caesarean sections, term IUFD, and second-trimester IUD delivery, presenting with heavy bleeding and retained placental tissues

Interventions: Ultrasonography confirmed retained placental tissues. Surgical procedure included laparoscopic excision, temporary ligation of bilateral uterine arteries with a shoe-lace knot, vasopressin injection for blood loss reduction, and uterine repair with a barbed suture to prevent isthmocele formation

Measurements and Main Results: Laparoscopic excision of placental tissue from the Caesarean scar site with temporary ligation of bilateral uterine arteries using a shoe-lace knot. The arteries were skeletonized and ligated with the same knot to reduce pulse pressure. Vasopressin was injected to minimize blood loss and facilitate bladder dissection. The uterine cavity was opened, and the entire placental tissue was extracted for histopathology. A large uterine defect was noted, and redundant scar edges were excised and sutured with a barbed suture to prevent isthmocele formation. Utilizing a barbed suture, care was taken to avoid tightening each stitch to prevent edge eversion and improve visualization of the uterine wall thickness. Bilateral uterine artery ligations were released, confirming hemostasis. The post-operative course was uneventful, with the patient remaining stable and free from abnormal bleeding during follow-up

Conclusion: Laparoscopy effectively addresses retained placenta accreta, offering removal, scar resection, and uterus repair while preserving fertility. Despite challenges such as bladder adhesion, this approach demonstrates promising outcomes with high success rates and minimal complications, positioning it as a safe and viable alternative to conservative or more invasive surgical methods