Brought to you by the Society of Gynecologic Surgeons. This video features a patient with a cesarean scar pregnancy who had failed a course of methotrexate but desired future fertility. The authors highlight a technique in which the blood supply is controlled with removable laparoscopic vascular clamps and the isthmocele is repaired in a fertility-sparing procedure. Ultrasound imaging is included from before the surgery and during the patient’s subsequent pregnancy.