An Effective Assisted Method Using Hysteroscopy Transmittance Test and a Foley Catheter to Repair Previous Cesarean Scar Defect by Laparoscopy

Abstract

Study objective: To introduce an effective assisted method using the hysteroscopy transmittance test and a Foley catheter to repair previous cesarean scar defect (PCSD) by laparoscopy.

Design: A step-by-step explanation of the surgery using video.

Setting: A university hospital.

Patients: A young woman with abnormal uterine bleeding.

Interventions: First, we inspected the pelvic cavity and detached the adhesion, opened the uterovesical peritoneal reflection, and pushed down the bladder. Then, the hysteroscopy transmittance test was used to confirm the site and the size of the PCSD. Next, a Foley catheter was inserted into the diverticulum through the cervical canal, and then we removed the diverticulum along the outer edge [1-4]. The myometrium and the serosal layer were sutured continuously with absorbable sutures. At this point, a second hysteroscopy transmittance test was performed to verify the repair effect. Finally, we placed antiadhesive film.

Measurements and main results: The location, size, and boundary of the PCSD can be exactly marked by this method. The operative time was 68 minutes, blood loss was 20mL, and no complications occurred.

Conclusion: This surgical method has the following benefits: the resection of the diverticulum is complete, and the suture is exact; it is suitable for patients with a thin diverticulum wall, large diverticulum cavity, and a long duration of bleeding after menstruation; the hysteroscopy transmittance test was used to confirm the site of the PCSD and verify the repair effect; and the Foley catheter can marker the resection site, prevent gas leakage, and stop bleeding by local compression.

Keywords: Cesarean scar defect; Foley catheter; Hysteroscopy; Laparoscopy; Transmittance test.