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. 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. --- SHOW NOTES 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.