Journal of minimally invasive gynecology最新文献

{"title":"Ten Tips and Tricks for Posterior Cul De Sac Dissection","authors":"AE Snyder ,&nbsp;M Truong","doi":"10.1016/j.jmig.2025.09.144","DOIUrl":"10.1016/j.jmig.2025.09.144","url":null,"abstract":"<div><h3>Study Objective</h3><div>Endometriosis and other etiologies of pelvic adhesive disease can distort anatomy, increasing the risk of injury to the rectum and other pelvic structures. Knowledge of pelvic anatomy and precise technique are essential when traveling from safe anatomic landmarks toward areas of disease in the posterior cul-de-sac. The objectives of this video are to: 1.Review the anatomy of the rectovaginal space and pelvic retroperitoneum. 2.Describe tips and tricks for posterior cul-de-sac dissection while avoiding rectal injury</div></div><div><h3>Design</h3><div>educational video</div></div><div><h3>Setting</h3><div>operating room, laparoscopic or robotic-assisted surgery</div></div><div><h3>Patients or Participants</h3><div>patients with endometriosis or pelvic adhesive disease</div></div><div><h3>Interventions</h3><div>minimally invasive gynecologic surgery: adhesiolysis, rectovaginal dissection and excision of endometriosis</div></div><div><h3>Measurements and Primary Results</h3><div>This video includes 10 key points to perform safe dissection of the rectovaginal space. These include tips to optimize (1) exposure and (2) identification of key anatomic landmarks in the rectovaginal and pararectal spaces. Recommendations for (3) choosing dissection instruments, (4) approaches for safely performing adhesiolysis and interrogating tissue as well as (5) specific dissection techniques are then reviewed. Focus is then directed to dissection of the rectum by (6) utilizing and navigating perirectal fat planes and (7) delineating the rectum from vagina. Finally, tips for (8) maintaining visualization and controlling bleeding, (9) optimally performing lesion excision after restoring anatomy, and (10) evaluating, testing, and repairing superficial rectal injury are reviewed.</div></div><div><h3>Conclusion</h3><div>Precise surgical technique is needed in combination with knowledge of pelvic anatomy to approach dissection of an obliterated rectovaginal space. These tips can help safely perform complex dissections.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S34"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Laparoscopic Management of Cesarean Scar Pregnancy","authors":"B. Lin ,&nbsp;E. Crihfield","doi":"10.1016/j.jmig.2025.09.086","DOIUrl":"10.1016/j.jmig.2025.09.086","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present the case and surgical video of a robotic-assisted laparoscopic excision of a cesarean scar pregnancy at 13 weeks and 5 days gestation</div></div><div><h3>Design</h3><div>Case report and surgical video</div></div><div><h3>Setting</h3><div>Hospital</div></div><div><h3>Patients or Participants</h3><div>One patient</div></div><div><h3>Interventions</h3><div>37 yo G7P4115 at 11 weeks 2 days gestation with history of 5 prior term low transverse cesarean deliveries presents for initial prenatal care. At dating sonogram by maternal fetal medicine, a cesarean scar pregnancy is diagnosed at 12 weeks 4 days gestation. Patient undergoes robotic-assisted laparoscopic excision of cesarean scar pregnancy with dilation and curettage at 13 weeks and 5 days gestation.</div></div><div><h3>Measurements and Primary Results</h3><div>Robotic-assisted laparoscopic excision of cesarean scar pregnancy was completed successfully without intraoperative or postoperative complications. Use of bulldog clamps and vasopressin helps minimize blood loss. Use of curettage under laparoscopic guidance helps ensure complete removal of products of conception. Debridement and excision of scar helps ensure secure closure of defect.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted laparoscopic excision of cesarean scar pregnancy at 13 weeks and 5 days gestation can be completed successfully with good outcomes by using intraoperative clamps and vasopressin, laparoscopic-guided curettage, and sufficient scar debridement and excision.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S9"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the Challenge Become Routine? Robotic Approach to Deep Pelvic Endometriosis","authors":"LSVilas Boas ,&nbsp;M Corinti ,&nbsp;T Rocha ,&nbsp;TC Dantas ,&nbsp;G Anderman Silva Barison ,&nbsp;MVG Tamura","doi":"10.1016/j.jmig.2025.09.140","DOIUrl":"10.1016/j.jmig.2025.09.140","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate that a procedure once considered highly challenging can become simpler and safer when performed in a systematic manner, guided by anatomical knowledge and supported by advanced surgical technology.</div></div><div><h3>Design</h3><div>Edited surgical video with narration, describing the stepwise systematization of a robotic-assisted deep endometriosis surgery, with emphasis on key anatomical landmarks.</div></div><div><h3>Setting</h3><div>The procedure was performed at a tertiary care hospital with access to a robotic platform. The patient was placed in lithotomy position, with lateral docking of the robot. Two robotic trocars were positioned in the iliac fossae bilaterally, and one 11 mm laparoscopic assistant trocar was placed in the right flank.</div></div><div><h3>Patients or Participants</h3><div>A 36-year-old woman with a two-year history of infertility, severe chronic pelvic pain, and deep dyspareunia. Imaging studies revealed deep endometriosis involving the posterior vaginal wall, rectum, and proximity to the hypogastric nerves, in addition to a solid ovarian mass.</div></div><div><h3>Interventions</h3><div>A systematic approach for complete excision of endometriotic lesions and right oophoroplasty:</div><div><ul><li><span>1.</span><span><div>Excision of peritoneal lesions in the vesicouterine fold</div></span></li><li><span>2.</span><span><div>Right oophoroplasty</div></span></li><li><span>3.</span><span><div>Access to pararectal spaces, ureterolysis, and nerve-sparing peritonectomy of the posterior compartment</div></span></li><li><span>4.</span><span><div>Dissection of the rectovaginal space with rectal mobilization</div></span></li><li><span>5.</span><span><div>Rectal discoid resection</div></span></li><li><span>6.</span><span><div>Review of anatomical structures and hemostasis</div></span></li></ul></div></div><div><h3>Measurements and Primary Results</h3><div>Complete excision of endometriotic lesions was achieved without complications related to bowel resection or bladder function. The patient was discharged on postoperative day 3, having progressed to a light diet. She experienced significant pain relief and was cleared for pregnancy two months after surgery.</div></div><div><h3>Conclusion</h3><div>The systematic surgical approach, combined with the precision of robotic assistance, allows highly complex procedures to be performed in a safer, more standardized, and reproducible manner.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S32-S33"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic Fimbrioplasty: Revisiting a Fertility Optimizing Technique for a Common Pathologic MIGS Finding","authors":"W Nolan ,&nbsp;K Fitts ,&nbsp;R Barbaresso ,&nbsp;S Parikh ,&nbsp;R Paya Pasic","doi":"10.1016/j.jmig.2025.09.129","DOIUrl":"10.1016/j.jmig.2025.09.129","url":null,"abstract":"<div><h3>Study Objective</h3><div>To present opportunistic fimbrioplasty and its potential benefits</div></div><div><h3>Design</h3><div>Surgical video presentation</div></div><div><h3>Setting</h3><div>Academic Hospital</div></div><div><h3>Patients or Participants</h3><div>Patient undergoing tubal reconstructive surgery</div></div><div><h3>Interventions</h3><div>Tubal reconstructive surgery</div></div><div><h3>Measurements and Primary Results</h3><div>Surgical video</div></div><div><h3>Conclusion</h3><div>Fimbrioplasty is a viable treatment option for simple hydrosalpinx</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S29"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Simulation Model for Minimally Invasive Ovarian Cystectomy","authors":"C. Liao ,&nbsp;S. Fisher ,&nbsp;W. Wieczorek ,&nbsp;D. DeFilippis ,&nbsp;M. Truong","doi":"10.1016/j.jmig.2025.09.068","DOIUrl":"10.1016/j.jmig.2025.09.068","url":null,"abstract":"<div><h3>Study Objective</h3><div>The objectives of this video are to: 1) Describe the development of a low-cost ovarian cystectomy model, 2) Review tips and tricks for ovarian cystectomy, and 3) To use the model in a simulation setting for resident education.</div></div><div><h3>Design</h3><div>This low-cost and reusable model is easily made with commonly found supplies and costs about $2.08 per model.</div></div><div><h3>Setting</h3><div>N/A</div></div><div><h3>Patients or Participants</h3><div>Ob/Gyn resident physicians participated in the simulation as a part of their educational didactics.</div></div><div><h3>Interventions</h3><div>N/A</div></div><div><h3>Measurements and Primary Results</h3><div>Eighty-two percent of residents felt that the model was effective for simulation of an ovarian cystectomy. Ninety-one percent of residents felt that the simulation would help to improve performance during the actual clinical setting. Eighty-two percent of residents felt more confident going into their next ovarian cystectomy. All residents reported that they would be likely to use the techniques learned in the simulation during their next ovarian cystectomy.</div></div><div><h3>Conclusion</h3><div>This novel, low-cost simulation model is an effective tool in teaching surgical skills for ovarian cystectomy and in increasing confidence in the operating room.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S4"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Tube, Still Ectopic: Laparoscopic Resection of Interstitial Pregnancy","authors":"E. Farabee,&nbsp;R. Barbaresso,&nbsp;W. Nolan,&nbsp;R. Paya Pasic,&nbsp;S. Parikh","doi":"10.1016/j.jmig.2025.09.072","DOIUrl":"10.1016/j.jmig.2025.09.072","url":null,"abstract":"<div><h3>Study Objective</h3><div>To demonstrate the treatment of an interstitial ectopic pregnancy in the setting of unilateral fallopian tube agenesis.</div></div><div><h3>Design</h3><div>Case report with surgical video.</div></div><div><h3>Setting</h3><div>Academic tertiary care hospital.</div></div><div><h3>Patients or Participants</h3><div>A single patient.</div></div><div><h3>Interventions</h3><div>28-year-old G5P0122 with history of cesarean section x1, cholecystectomy, and laparoscopic gastric sleeve presented with vaginal bleeding and mild abdominal pain at approximately 6 weeks gestation. Interstitial ectopic pregnancy identified on ultrasound and MRI. Patient underwent laparoscopic resection at which time unilateral agenesis of the right fallopian tube was identified.</div></div><div><h3>Measurements and Primary Results</h3><div>Laparoscopic excision of interstitial ectopic pregnancy was completed successfully without intra- or post-operative complications and with minimal blood loss. Surgical technique was reviewed in the video. Patient was discharged on the day of surgery and had an uncomplicated surgical recovery. Final pathology was consistent with products of conception.</div></div><div><h3>Conclusion</h3><div>An interstitial ectopic pregnancy is a potential complication of unilateral fallopian tube agenesis.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S5"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applications of Near-Infrared Technology in Minimally Invasive Gynecologic Surgery","authors":"RM Nuss ,&nbsp;R Sobota ,&nbsp;M Truong ,&nbsp;AE Snyder ,&nbsp;L Cosgriff ,&nbsp;CB Iglesia","doi":"10.1016/j.jmig.2025.09.101","DOIUrl":"10.1016/j.jmig.2025.09.101","url":null,"abstract":"<div><h3>Introduction</h3><div>In complex gynecologic surgery, proper identification of anatomy and careful dissection of tissue planes is imperative. Near-infrared Fluorescence (NIRF) with and without indocyanine green dye (ICG) is a technology that has traditionally been used in general surgery and gynecologic oncology mostly for tissue perfusion assessment and sentinel node mapping but has increasingly been applied in benign gynecologic surgery as a tool for anatomy identification and dissection.</div></div><div><h3>Study Objective</h3><div>The objectives of this video are to: 1) provide an overview of NIRF, 2) review applications of NIRF in benign gynecologic surgery, and 3) demonstrate examples of this technology with and without ICG in benign gynecologic surgery.</div></div><div><h3>Design</h3><div>Educational video highlighting applications of NIRF with and without ICG in benign gynecologic surgery.</div></div><div><h3>Setting</h3><div>Academic Medical Center.</div></div><div><h3>Patients or Participants</h3><div>Cases with relevant usage of NIRF-ICG.</div></div><div><h3>Interventions</h3><div>Gynecologic surgery.</div></div><div><h3>Measurements and Primary Results</h3><div>This video provides an overview of applications of NIRF with and without ICG in a variety of gynecologic surgical scenarios, including ureteral identification, bladder dissection, myomectomy, and isthmocele resection. We demonstrate identification of critical anatomy and dissection planes in complex cases, such as deep infiltrating endometriosis. We discuss varying routes and dosages of ICG for specific surgical purposes.</div></div><div><h3>Conclusion</h3><div>NIRF with and without ICG has a wide variety of applications in benign gynecologic surgery and can be a useful tool for identification of anatomy and dissection planes for both trainees and experienced surgeons.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S19"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Ohvira Requiring Laparoscopic Hemihysterectomy","authors":"E Lehembre-Shiah,&nbsp;K Das,&nbsp;A Mayhew","doi":"10.1016/j.jmig.2025.09.102","DOIUrl":"10.1016/j.jmig.2025.09.102","url":null,"abstract":"<div><h3>Study Objective</h3><div>Our goal in this video is to present an unusual case of OHVIRA requiring laparoscopic hemihysterectomy. We share our approach to pre-operative surgical planning and intra-operative decision-making in these difficult cases and then we demonstrate our surgical technique for performing a laparoscopic hemihysterectomy for this particular variant of OHVIRA syndrome.</div></div><div><h3>Design</h3><div>Case presentation of the pre-operative and intra-operative process with video documentation.</div></div><div><h3>Setting</h3><div>We performed a laparoscopic hemihysterectomy in the operating room of a children's hospital. The patient was placed in dorsal low-lithotomy position.</div></div><div><h3>Patients or Participants</h3><div>A 14-year-old female with OHVIRA syndrome causing chronic pelvic pain.</div></div><div><h3>Interventions</h3><div>Laparoscopic hemihysterectomy</div></div><div><h3>Measurements and Primary Results</h3><div>Resolution of pelvic pain and removal of menstrual obstruction.</div></div><div><h3>Conclusion</h3><div>In certain OHVIRA anomaly variants, laparoscopic hemihysterectomy is the most appropriate surgical approach. A combined ultrasound and physical-exam assessment in the operating room, can help enhance decision-making ability regarding best surgical approach for OHVIRA variants. This strategy can help prevent failed initial attempts at vaginal resection which lead to increased OR time, post-op pain, and surgical complications.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S19"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ilioinguinal and Iliohypogastric Nerve Block: A Low Fidelity Task Trainer","authors":"HC Kelly,&nbsp;J Wu,&nbsp;M Lachiewicz","doi":"10.1016/j.jmig.2025.09.104","DOIUrl":"10.1016/j.jmig.2025.09.104","url":null,"abstract":"<div><h3>Study Objective</h3><div>To create and describe a low-fidelity model that highlights key anatomical landmarks for ilioinguinal and iliohypogastric nerve blocks. This cost-effective tool allows trainees to practice and master procedural techniques. By enhancing these skills, the trainer will increase trainees’ confidence in performing nerve blocks to combat postoperative neuropathic pain related to obstetrical and gynecological procedures.</div></div><div><h3>Design</h3><div>This descriptive educational simulation project reviews the patient population that might benefit from these injections and presents an evidence-based approach for detecting nerve pathways. It describes the materials and methods used to construct the model, providing a side-by-side demonstration of the simulated vs. actual procedural walkthrough of the technique.</div></div><div><h3>Setting</h3><div>The task trainer is intended for any educational environment (e.g., classroom, procedure lab) using standard table-height positioning to approximate the ergonomics of performing in the clinic or operating room. The low-stakes setting provides an opportunity to practice identifying landmarks and build muscle memory.</div></div><div><h3>Patients or Participants</h3><div>The model was developed exclusively for simulation-based teaching for OB/GYN residents. No patients or live participants were involved.</div></div><div><h3>Interventions</h3><div>Cost-effective, accessible supplies were used to construct a model of the lower abdominal tissue planes and landmarks necessary for nerve blocks. The trainer simulates the force required to pop through the fascia into the target foam abdominal wall. This tactile feedback is critical for enhancing trainees’ identification of key anatomy and effective blockade.</div></div><div><h3>Measurements and Primary Results</h3><div>With supplies valued at about $20 and a design incorporating cadaveric data, the model offers educators a method for teaching spatial awareness and procedural skills.</div></div><div><h3>Conclusion</h3><div>This abdominal model, made from inexpensive materials, optimizes tactile simulation of ilioinguinal and iliohypogastric nerve blocks. Its simplicity and replicability make it ideal for reinforcing anatomical knowledge and supporting skill development in an educational setting.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Page S20"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Isthmocele Repair: A Review of Surgical Principles in a Patient Desiring Future Fertility","authors":"N.T. Catalano ,&nbsp;S. Tillotson ,&nbsp;C.L. Reese","doi":"10.1016/j.jmig.2025.09.085","DOIUrl":"10.1016/j.jmig.2025.09.085","url":null,"abstract":"<div><h3>Study Objective</h3><div>To assess the safety and effectiveness of minimally invasive approaches for isthmocele repair in a patient desiring future fertility.</div></div><div><h3>Design</h3><div>Video case presentation of a single patient undergoing robotic-assisted isthmocele excision and repair, performed outpatient with postoperative follow-up.</div></div><div><h3>Setting</h3><div>The patient was placed in dorsal lithotomy position with arms tucked. She was prepped and draped in standard sterile fashion per robotic surgery protocol. A Foley catheter and OG tube were inserted using sterile technique.</div></div><div><h3>Patients or Participants</h3><div>A 31-year-old G1P1001 woman presented with persistent pelvic pain 19 months after a low transverse cesarean complicated by chorioamnionitis and hysterotomy extension. Imaging confirmed a 5.4mm x 1.7mm isthmocele. Desiring future fertility, she provided informed consent for robotic-assisted excision and repair.</div></div><div><h3>Interventions</h3><div>Robotic-assisted excision and repair of the isthmocele was performed using minimally invasive techniques. Retrograde bladder filling aided anatomical orientation. The right broad ligament was opened to allow a lateral-to-medial dissection for vascular preservation. Hysteroscopy with transillumination guided identification of the isthmocele. Fluorescence imaging enhanced localization of the defect. After excision, the uterine wall was closed in two layers using barbed suture. Post-repair hysteroscopy confirmed decreased transillumination and water-seal, confirming closure of the defect.</div></div><div><h3>Measurements and Primary Results</h3><div>The surgery was complication-free. The patient was discharged the same day without adverse events. She is doing well on Nuvaring contraception; however, follow-up imaging has not been performed due to financial constraints.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted isthmocele excision and repair provides a safe, minimally invasive option for patients seeking future fertility. Continued follow-up and further studies are needed to assess long-term outcomes.</div></div>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":"32 11","pages":"Pages S8-S9"},"PeriodicalIF":3.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}