Single-port robot-assisted repair of cesarean scar defect using the da Vinci SP system with near-infrared and simultaneous multi-image display for precise defect localization and excision

Objective: To present a detailed surgical video demonstrating the single-port (SP) robot-assisted repair of a cesarean scar defect (CSD) using the da Vinci SP system (Intuitive Surgical, Sunnyvale, CA, USA), with particular emphasis on hysteroscopic and near-infrared imaging guidance for accurate localization and excision of the defect. Methods: This case report describes a patient with symptomatic CSD who underwent single-port robot-assisted repair using the da Vinci SP system system (Intuitive Surgical). Concurrent hysteroscopy was performed to delineate the isthmocele from the uterine cavity and to support intraoperative orientation. Near-infrared imaging was performed to visualize the defect on the abdominal side. Because near-infrared imaging alone may not sufficiently define the true excision margin, a simultaneous multi-image display was used to enable real-time correlation between the hysteroscopic and intra-abdominal views. The excision line was carefully determined on the basis of this combined visualization, followed by controlled resection of the fibrotic tissue and multilayer uterine reconstruction. Results: The video illustrates each procedural step, including single-port access, bladder dissection, hysteroscopy-assisted identification of the defect, near-infrared-guided marking of the resection margin, precise excision, and secure multilayer uterine closure. The combined visualization approach facilitated clear intraoperative orientation and identification of the defect margin, allowing precise excision and repair of the CSD while maintaining cosmetic integrity. Conclusion: This video provides an educational demonstration of a feasible single-port robot-assisted technique for CSD repair. The integration of hysteroscopy and near-infrared imaging with a simultaneous multi-image display may assist in intraoperative decision-making and support precise excision and reconstruction in minimally invasive CSD surgery.