Use of a Hysteroscopic Tissue Removal System for Revision of Cesarean Scar Isthmocele: A Case Report

Cesarean scar isthmocele (CSI) is a defect in the anterior myometrial wall of the uterine isthmus, at the site of a previous cesarean scar, and can be associated with menorrhagia in the form of prolonged menstrual bleeding or spotting, dysmenorrhea, and/or secondary subfertility. We report a case of hysteroscopic morcellation of CSI with a subsequent successful pregnancy. A 37-year-old female with menorrhagia since cesarean delivery and secondary subfertility, with midcycle transvaginal sonogram (TVS) showing a CSI with associated endometrial cavity fluid (ECF) as well as a small endometrial polyp, underwent hysteroscopic revision of the CSI and polypectomy via a tissue removal system. Postoperatively, menorrhagia had resolved, and follow-up midcycle TVS imaging showed no ECF. The patient spontaneously conceived 3 months after surgery and achieved a successful pregnancy. The use of a hysteroscopic tissue removal system is a feasible approach to the revision of CSI. Larger studies are necessary in order to determine efficacy for fertility patients.