Cesarean scar pregnancy (CSP) refers to the implantation of a gestational sac, fertilized egg or embryo in the scar of the uterine cesarean incision. As a rare and highly consequential distant complication of cesarean section, its treatment needs to be taken seriously with the liberalization of the policy of two separate children, despite its low probability of occurrence. If CSP is not diagnosed or misdiagnosed in time, the main risk is that it can cause serious consequences such as uterine rupture and hemorrhage, so early diagnosis and timely treatment are especially important. Currently, the goal of treatment for cesarean scar pregnancy is to kill the embryo, reduce bleeding and preserve the patient’s reproductive function before the gestational sac ruptures and bleeds. Since 2006, Shengjing Hospital of China Medical University has been trying to perform hysteroscopic CSP lesion electrosurgery in patients with confirmed CSP, and has achieved good treatment results. Compared with aspiration and uterine artery embolization, hysteroscopic CSP lesion electrosurgery treatment has the features of being able to operate under direct vision, reducing bleeding, exact lesion removal, rapid decrease of serum β-hCG, and rapid local mass absorption. With the gradual accumulation of cases, we found that not all patients can achieve satisfactory results. Some patients treated by hysteroscopic surgery may have high intraoperative and postoperative bleeding, slow decline of serum β-hCG, long postoperative local mass absorption time or high percentage of needing secondary disposal. The analysis revealed that these patients with poor outcome were ectopic CSP, i.e. the gestational sac was located deep in the scar, growing toward the myometrium or toward both the myometrium and the uterine cavity, with deep implantation of the gestational sac and heavy adhesions to the scar and the adjacent myometrium. There are even clinical cases where the smaller gestational sacs grow completely within the myometrium of the scar, and some of the larger ones protrude outside the uterine contour or even press on the bladder. The implantation of the gestational sac can cause severe localized myometrial defect and destruction in ectopic CSP. Multiple factors increase the risk and difficulty of surgery Analysis of the causes reveals that in such patients, if treated with the help of hysteroscopy, effective hemostasis cannot be performed intraoperatively by physiological ligation of vessels by contraction of uterine smooth muscle, and only hysteroscopic electrocoagulation of the trauma can be relied on, which is an important reason for more intraoperative bleeding and slower absorption of local masses after surgery. In addition, the ectopic CSP gestational sac is often markedly convex, the uterine wall is extremely thin at the lesion, and the distance between the lesion and the bladder wall is small, which, together with the interference of intraoperative bleeding, makes it difficult for hysteroscopic electrodesiccation to completely remove the chorionic tissue implanted in the myometrium, resulting in a slower postoperative decrease in serum β-hCG and may also cause serious surgical complications such as uterine perforation and bladder wall injury. Finally, even if the hysteroscopic surgery is successful in removing the ectopic CSP lesion, the thickness of the incisional scar remains unchanged or even thinner than before surgery, which is not conducive to removing the underlying cause of CSP and the possibility of CSP occurring in subsequent pregnancies. Considering the great risk of hysteroscopic treatment of exophytic scar pregnancy, we started to try laparoscopic removal of the lesion in 2009. In recent years, it has been confirmed that laparoscopic resection of CSP lesions can not only remove the lesions completely, remove the tiny slit, repair the scar and reduce the risk of recurrence, but also decrease the serum β-hCG quickly. More importantly, it has the characteristics of less time consuming, less bleeding and faster recovery, preserving the patient’s fertility, and is especially suitable for the treatment of ectopic CSP. In recent years, with the increase of women having cesarean section and having second child, the number of patients with scar pregnancy is gradually increasing in the clinic. For clinicians, especially primary care physicians, we believe it is important to be able to accurately identify scar pregnancies. Once an exophytic scar pregnancy is detected, it is important not to perform operations such as blind scraping, but to actively refer the patient to a higher level hospital.