Design: Stepwise demonstration of surgical technique with narrated video footage.

Setting: OR setting, Henry Ford Health, Detroit, Michigan.

Patients or Participants: Case report of a 40yo G2P2 female who developed sepsis secondary to an infected isthmocele.

Interventions: Diagnostic hysteroscopy to identify isthmocele followed by total laparoscopic hysterectomy, bilateral salpingectomy. The key surgical steps are as follows:

• Identification of isthmocele
• Review of isthmocele anatomy from hysteroscopic and laparoscopic perspective
• Techniques for adhesiolysis in the setting isthmocele adhered to bladder

Measurements and Main Results: Ishtmocele is a wedge-shaped defect in the uterus at the previous cesarean hysterotomy site. It can lead to abnormal uterine bleeding, infertility, and infection. Isthmocele can be densely adhered to the bladder, making the hysterectomy challenging.

Conclusion: This video demonstrates the appropriate identification of an isthmocele and the anatomical landmarks and surgical technique involved in the hysterectomy.