Circulating Exosomal ANRIL is a Novel Prognostic Marker for Epithelial Ovarian Cancer

Abstract

This video presents a stepwise approach to the hysteroscopic resection of cesarean scar isthmocele. Design: Surgical video. Settings: This video takes place in an academic medical centre. Patients: Two cases are presented to highlight the surgical steps and technical tips in successfully performing the hysteroscopic resection of a cesarean scar isthmocele. Appropriate surgical candidates include patients who have a symptomatic isthmocele and a residual myometrial thickness of at least 3 mm. Interventions: Operative hysteroscopy is performed for the identification and treatment of a cesarean scar isthmocele. The cephalad and caudad edges of fibrosis bordering the isthmocele are resected following which, ablation of the endometrium within the isthmocele is performed. Measurements/Results: Cesarean scar isthmocele is defined as a wedgeshaped defect, measuring at least 1-2 mm in depth, in the anterior wall of the uterus at the prior cesarean scar site. When symptomatic, isthmoceles most commonly present with abnormal uterine bleeding in the form of postmenstrual spotting. Hysteroscopic resection of an isthmocele, otherwise called hysteroscopic isthmoplasty, is one surgical approach to treatment of this condition. This video presents a stepwise approach to this procedure that involves identifying relevant anatomy, resecting the cephalad edge of fibrosis, resecting the caudad edge of fibrosis, and ablating the isthmocele. The objective of the procedure is to restore the normal contour between the uterine cavity and cervical canal. Conclusions: Hysteroscopic resection of a cesarean scar isthmocele successfully performed in the two cases presented in this video. Postoperatively, both patients had resolution of their symptoms. This procedure should be offered to patients with a symptomatic isthmocele. More evidence is required on whether it is safe to perform this procedure in patients who desire future fertility.