{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T18:50:46Z","timestamp":1776883846084,"version":"3.51.2"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A uterine isthmocele, or cesarean scar defect, is a complication of cesarean delivery. This report presents a 36-year-old female patient with chronic pelvic pain and uterine bleeding years after a cesarean delivery. Initially, conservative treatment did not alleviate these symptoms. Upon failing conservative measures for symptom relief, she elected to undergo a definitive surgical repair. The patient underwent diagnostic hysteroscopy followed by robotic-assisted laparoscopic repair. Intraoperative evaluation revealed a 2\u20133\u00a0cm niche at the lower uterine segment, which was excised and reconstructed in two layers. Bilateral tubal patency and a watertight closure were confirmed with methylene blue instillation. The procedure was completed without complications and with minimal blood loss. Postoperative recovery was uncomplicated, and the patient reported early symptom improvement. This case demonstrates a minimally invasive surgical technique in a patient with a symptomatic isthmocele and serves to inform osteopathic practitioners of considerations when encountering patients with post-cesarean sequelae.<\/jats:p>","DOI":"10.1093\/jscr\/rjag288","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:47:55Z","timestamp":1775130475000},"source":"Crossref","is-referenced-by-count":0,"title":["Robotic-assisted laparoscopic repair of a symptomatic uterine isthmocele following cesarean delivery: a case report"],"prefix":"10.1093","volume":"2026","author":[{"given":"Mishalle","family":"Rashid","sequence":"first","affiliation":[{"name":"Edward Via College of Osteopathic Medicine , Virginia Campus, 2265 Kraft Drive, Blacksburg, VA 24060 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Rashid","sequence":"additional","affiliation":[{"name":"George Mason University , 4400 University Drive, Fairfax, VA 22030 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahan L","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, About Women OB\/GYN \/ Sentara Northern Virginia Medical Center , 2300 Opitz Boulevard, Woodbridge, VA 22191 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"2026042214121262400_ref1","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1002\/uog.13199","article-title":"Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: systematic review","volume":"43","author":"Bij de Vaate","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2026042214121262400_ref2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/uog.6405","article-title":"Cesarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position","volume":"34","author":"Wang","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"key":"2026042214121262400_ref3","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jmig.2012.12.006","article-title":"Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in nonpregnant women","volume":"20","author":"Marotta","year":"2013","journal-title":"J Minim Invasive Gynecol"},{"key":"2026042214121262400_ref4","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/uog.6395","article-title":"High prevalence of defects in cesarean section scars at transvaginal ultrasound examination","volume":"34","author":"Osser","year":"2009","journal-title":"Ultrasound Obstet 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Gynecol"},{"key":"2026042214121262400_ref8","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1007\/s00404-025-08238-6","article-title":"Isthmocele risk in repeated cesarean: the diagnostic and clinical role of morphometric parameters","volume":"312","author":"\u00d6z\u00fcm","year":"2025","journal-title":"Arch Gynecol Obstet"},{"key":"2026042214121262400_ref9","doi-asserted-by":"crossref","first-page":"695","DOI":"10.7863\/jum.2003.22.7.695","article-title":"The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy","volume":"22","author":"Fabres","year":"2003","journal-title":"J Ultrasound Med"},{"key":"2026042214121262400_ref10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1111\/1471-0528.14733","article-title":"Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial","volume":"125","author":"Vervoort","year":"2018","journal-title":"BJOG"},{"key":"2026042214121262400_ref11","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s11701-022-01502-w","article-title":"Robot-assisted laparoscopic repair of cesarean scar defect: a systematic review of clinical evidence","volume":"17","author":"Gkegkes","year":"2023","journal-title":"J Robot Surg"},{"key":"2026042214121262400_ref12","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.3390\/medicina61071123","article-title":"Minimally invasive surgery for the excision and repair of cesarean scar defect: a scoping review of the literature","volume":"61","author":"Surico","year":"2025","journal-title":"Medicina (Kaunas)"},{"key":"2026042214121262400_ref13","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.tjog.2021.07.007","article-title":"Robotic or laparoscopic treatment of cesarean scar defects or cesarean scar pregnancies with uterine sound guidance","volume":"60","author":"Wang","year":"2021","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2026042214121262400_ref14","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1186\/s12905-023-02715-3","article-title":"A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect","volume":"23","author":"Allameh","year":"2023","journal-title":"BMC Womens Health"},{"key":"2026042214121262400_ref15","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1002\/ijgo.16080","article-title":"Reproductive outcomes after surgical resection of isthmocele in secondary infertility","volume":"169","author":"Pir\u00f3g","year":"2025","journal-title":"Int J Gynaecol Obstet"}],"container-title":["Journal of Surgical Case 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