A novel approach for cesarean scar defect repair: translating hysteroscopic markings into laparoscopic precision with the Taurus T method

Abstract

Objective: To present the "Taurus T Method," a novel 3-step approach that simplifies our previously reported nonperfusion hysteroscopy technique for cesarean scar defect (CSD) repair by eliminating the need for simultaneous screen monitoring.

Design: A technical video introducing the laparoscopic repair of CSD using the "Taurus T Method." This study was approved by the institutional review board (approval number: R22-093).

Subjects: A 35-year-old woman presented with secondary infertility after a cesarean section performed 3 years ago at 38 weeks of gestation because of breech presentation. She underwent 4 cycles of intrauterine insemination and 4 embryo transfers via in vitro fertilization for unexplained infertility, but none resulted in pregnancy. During infertility treatment, she experienced irregular bleeding, and ultrasonography revealed blood pooling in the CSD.

Exposure: The "Taurus T Method" involves 3 key surgical steps: Step 1: Under hysteroscopic guidance, mark the cephalad and caudal ends of the defect with straight needles. Step 2: Insert a Hegar dilator into the defect and bend the uterine fundus dorsally to achieve a retroverted position. This procedure generates the "Taurus sign," ensuring optimal uterine positioning for the resection of the CSD lesion within the laparoscopic field of view. Step 3: Perform a T-shaped excision between the needles: a vertical incision followed by a horizontal cut along the cephalad margin. The needle markings translate hysteroscopic findings into a laparoscopic view, allowing surgeons to focus on the laparoscopic screen during the excision phase.

Main outcome measures: Complete excision of the CSD and improvement in patient symptoms through the 3-step surgical technique.

Results: The "Taurus T Method" achieved accurate CSD excision, although recognizing both the vertical and lateral extent through the laparoscopic view minimizing unnecessary tissue removal.

Conclusion: The "Taurus T Method" is a systematic approach for accurately identifying and removing the CSD. The "Taurus sign" enables recognition of the defect's vertical extent, whereas the T-shaped incision allows precise visualization of its lateral extent, ensuring complete excision.

Keywords: Cesarean scar defect; cesarean scar disorder; hysteroscopy; isthmoceles; niche.