MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. SiedhoffThe minimally invasive approach to the symptomatic isthmocele – what does the literature say? A step-by-step primer on laparoscopic isthmocele – excision and repairSipahi, Sevgi; Sasaki, Kirsten; Miller, Charles E.Author Information Department of Obstetrics & Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA Correspondence to Charles E. Miller, MD, FACOG, Department of Obstetrics & Gynecology, Advocate Lutheran General Hospital, 1775 Dempster Street, 4 South, Park Ridge, IL 60068, USA. E-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-obgyn.com). Current Opinion in Obstetrics and Gynecology: August 2017 - Volume 29 - Issue 4 - p 257-265 doi: 10.1097/GCO.0000000000000380 Buy SDC Metrics Abstract Purpose of review The purpose of this review is to understand the minimally invasive approach to the excision and repair of an isthmocele. Recent findings Previous small trials and case reports have shown that the minimally invasive approach by hysteroscopy and/or laparoscopy can cure symptoms of a uterine isthmocele, including abnormal bleeding, pelvic pain and secondary infertility. A recent larger prospective study has been published that evaluates outcomes of minimally invasive isthmocele repair. Smaller studies and individual case reports echo the positive results of this larger trial. Summary The cesarean section scar defect, also known as an isthmocele, has become an important diagnosis for women who present with abnormal uterine bleeding, pelvic pain and secondary infertility. It is important for providers to be aware of the effective surgical treatment options for the symptomatic isthmocele. A minimally invasive approach, whether it be laparoscopic or hysteroscopic, has proven to be a safe and effective option in reducing symptoms and improving fertility. https://links.lww.com/COOG/A37. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.