A Complex Case of Severe Cervical Stenosis and Isthmocele

Study Objective

To review specific considerations for isthmocele repair and abdominal cerclage and illustrate the surgical technique for transuterine cervical dilation, isthmocele repair and abdominal cerclage.

Design

Case Report

Setting

Academic tertiary referral center

Patients or Participants

33yo G1P1001 who presented with a retained IUD, cervical stenosis and shortening, and an isthmocele diagnosed on imaging.

Interventions

Laparoscopic transuterine IUD removal, isthmocele repair, cervical dilation with possible catheter insertion, and transabdominal cerclage.

Measurements and Primary Results

Patient underwent uncomplicated surgical procedure as described, intrauterine foley catheter was left in place to maintain cervical patency. At her 2-week postoperative visit, the catheter was removed and office hysteroscopy was performed without complication and with no need for cervical dilation.

Conclusion

This video emphasizes the importance of patient-centered care and shared decision-making in managing complex reproductive surgical cases, particularly when aligning with fertility preservation goals. It also highlights the value of multidisciplinary collaboration in guiding evidence-informed yet individualized care. Finally, the surgical approach demonstrates how minimally invasive techniques can be adapted to address multiple pathologies simultaneously, minimizing risk and optimizing future reproductive potential.