Sako Yusuke, Hirata Tetsuya
Department of Obstetrics and Gynecology, St. Luke's International Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, St. Luke's International Hospital, Tokyo, Japan; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Fertil Steril. 2025 Aug;124(2):378-380. doi: 10.1016/j.fertnstert.2025.03.034. Epub 2025 Apr 4.
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.
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).
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.
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.
Complete excision of the CSD and improvement in patient symptoms through the 3-step surgical technique.
The "Taurus T Method" achieved accurate CSD excision, although recognizing both the vertical and lateral extent through the laparoscopic view minimizing unnecessary tissue removal.
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.
