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BackTable / OBGYN / Podcast / Episode #50
Decoding Isthmocele: Causes and Considerations
with Dr. Chuck Miller
In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair.
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BackTable, LLC (Producer). (2024, April 2). Ep. 50 – Decoding Isthmocele: Causes and Considerations [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Chuck Miller
Dr. Charles (Chuck) Miller is the president and founder of the Advanced IVF Institute and the Advanced Gynecologic Surgery Institute in Naperville, Illinois.
Dr. Amy Park
Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.
Dr. Mark Hoffman
Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.
Synopsis
Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures.
Timestamps
00:00 - Introduction
07:18 - Defining Isthmocele and the History of Isthmocele
10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility
19:31 - Exploring Surgical Techniques for Isthmocele Repair
27:54 - Understanding Hysteroscopic Resection
30:12 - Addressing C-Section Ectopics and Isthmocele Repairs
36:46 - Adapting the Surgical Approach to Different Patient Scenarios
39:35 - Postoperative Complications and Safety Measures
40:55 - The Future of Isthmocele: Surgical Standardization
50:51 - Closing Thoughts and Acknowledgements
Resources
Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840.
Transcript Preview
[Dr. Chuck Miller]
It's an interesting entity because the first time it was talked about was 1995. That's an amazing thing when you think that this is such a very common problem. If you look on ultrasound and you look at where the C-section was performed, roughly 30 percent of women will have a niche, a defect in their C-section after their first, upwards to 60% and nearly 100% after their third. Yet, it was never really identified.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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