162 - Minimally Invasive Abdominal Cerclage Compared to Laparotomy: a Comparison of Surgical and Obstetric Outcomes

Abstract

Study Objective The objective of this study is to report surgical and obstetric outcomes of patients following abdominal cerclage placement through either minimally invasive (MIS) or open techniques. We previously published a study comparing eleven MIS and nine open abdominal cerclage recipients, and here we give an updated report on this infrequently performed procedure. Design Retrospective cohort study. Setting Referral centers specializing in high risk pregnancy and minimally invasive gynecologic surgery. Patients or Participants Women who underwent abdominal cerclage placement either during pregnancy or prior to conception via laparoscopy or laparotomy at Yale New Haven or Bridgeport Hospital between December 2011 through December 2019. Interventions One cohort of women had their abdominal cerclage placed using conventional or robotic-assisted laparoscopy. The other cohort consisted of women whose abdominal cerclage was placed through laparotomy. Electronic medical charts were reviewed to collect baseline demographic and pre-procedure obstetric information, as well as surgical and post-procedure obstetric outcomes. Measurements and Main Results Twenty-three minimally invasive and 14 open abdominal cerclages were performed during the study period. Fifteen of the MIS and three open cerclages were performed as interval procedures, when patients were not pregnant. Average operative time was longer in the minimally invasive cohort by 40 minutes. Estimated blood loss was lower in the minimally invasive group (43mL in MIS vs 167mL in open cohorts). Length of hospital stay was shorter in the MIS group (0.2 days vs 2.1 days). Post-procedure obstetric outcomes were similar between the two cohorts, and cerclages placed during pregnancy resulted in live birth or maintenance of pregnancy in 88% of MIS and 82% of open cases. Conclusion Minimally invasive abdominal cerclage is a safe alternative to laparotomy, when performed by a surgeon with appropriate training and technical skills, providing patients with improved surgical outcomes without impairing the obstetric outcomes.