# A Pharus Method for Laparoscopically Locating a Uterine Niche in Cesarean Scar Disorder

## TL;DR

A new method using advanced imaging helps locate and repair a uterine niche during laparoscopic surgery for cesarean scar disorder.

## Contribution

The first reported use of the Pharus method with real-time green light visualization for laparoscopic repair of CSDi.

## Key findings

- The Pharus method enabled precise delineation of the niche margins during surgery.
- The technique provided real-time anatomical guidance without reducing ambient lighting.
- The niche was successfully excised and the uterine wall reconstructed using barbed sutures.

## Abstract

Cesarean scar disorder (CSDi) is a pathological entity involving a myometrial defect at the site of a previous cesarean section, commonly associated with postmenstrual spotting, dysmenorrhea, and secondary infertility. While laparoscopic repair is an established treatment, intraoperative localization of the niche remains challenging.

We report a novel application of the Pharus method, which utilizes the full‐color IR white‐light overlay mode of a commercial imaging platform (ELITE III, Olympus, Tokyo, Japan) to enable real‐time visualization of hysteroscopic transillumination as green lights under bright‐field conditions. A 32‐year‐old woman diagnosed with CSDi underwent combined hysteroscopic and laparoscopic niche repair. The margins of the niche were precisely delineated, sharply excised, and the uterine wall was reconstructed in two layers using barbed sutures.

This is the first reported use of the Pharus method in the laparoscopic repair of CSDi. The technique enhances intraoperative anatomical guidance without the need for reduced lighting. This method may offer a valuable advancement in laparoscopic repair of CSDi.