Hysteroscopic assisted single-site robotic resection of cesarean scar defect (CSD): dual case reports and review of literature

The number of deliveries via cesarean section has increased in the United States, to a rate of 32.3%, which is almost double the global rate of 18.6%. With a greater rate of deliveries via cesarean section comes an increased rate of associated complications in subsequent pregnancies and longer hospital stays. One complication of cesarean section is the formation of a cesarean scar defect (CSD), niche or isthmocele which has no standard definition but can be grossly described as a disruption or defect in the myometrium associated with uterine scar. Approximately 1.9% of women are diagnosed with CSD; however the prevalence of CSD is difficult to quantify, given that smaller CSDs may be asymptomatic. As more women are encouraged towards trial of labor after cesarean (TOLAC), the performance of the uterus during labor is of growing concern due to the risk of uterine rupture.