Laparoscopy Minimally Invasive and Effective Treatment for Cesarean Scar Pregnancy: Review

The researchers found that laparoscopic excision of cesarean scar pregnancy is a highly effective and durable method, with minimal complications reported in existing studies. They also noted that this approach is particularly successful in cases where the CSP is embedded within the myometrium, regardless of whether the serosa is involved.

Cesarean Scar Pregnancy is a serious condition that occurs when a pregnancy implants in the scar tissue of the uterus following a cesarean section. If left untreated, CSP can lead to severe complications such as uterine rupture and excessive bleeding, both of which pose significant risks to the mother's health. In recent years, various treatment options have been explored for managing CSP, including expectant, medical, and surgical approaches.

Against the above background, Zaki Sleiman, Obstetrics & Gynecology Department, Lebanese American University, Beirut, Lebanon, and colleagues sought to assess the role of laparoscopy in managing cesarean scar pregnancy.

For this purpose, the researchers conducted an extensive search of PubMed and The Cochrane Library, focusing on studies published up to May 2024. Following multiple screening processes by two reviewers, 48 articles discussing laparoscopic management were included in the review.

The key findings of the review were as follows:

• Laparoscopy allows adhesiolysis, bladder dissection, and complete CSP excision in addition to simultaneous repair of the isthmocele, reinforcing the scarred myometrium to prevent abnormal uterine bleeding, pelvic pain, CSP recurrence, and rupture.
• The CSP gestational sac should be > 32.5 mm, with a myometrial thickness of < 2 mm, to ensure a successful indication of laparoscopy as the main treatment option.

"Laparoscopic treatment for cesarean scar pregnancy has emerged as a highly effective and minimally invasive option. With its ability to excise the pregnancy, repair the uterine scar, and prevent further complications, laparoscopy stands out as a preferred method for managing CSP, particularly in cases with a larger gestational sac and thinner myometrium," the researchers wrote. They added, "Ongoing research highlights its potential to reduce risks and improve outcomes for women facing this challenging condition."

Reference: Barakat, E., Riemma, G., Laganà, A. S., Nehme, L., Khazzaka, A., Noventa, M., Lukanovic, D., Hakimi, S., & Sleiman, Z. (2025). Laparoscopic treatment of cesarean scar pregnancy: A scoping review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 307, 154-163. https://doi.org/10.1016/j.ejogrb.2025.02.006