Laparoscopic Abdominal Cerclage: Ensuring the Best Fertility Outcome

Abstract

Study Objective To present the case of a patient undergoing fertility treatment, who required a Laparoscopic Abdominal Cerclage to improve fertility outcome. Design Descriptive video of Laparoscopic placement of Benson Cerclage. Setting Patient was in lithotomy position during surgery. One umbilical 5 mm port was used for the camera. Two 5 mm accessory ports were placed on both lower quadrants, and a left lateral 5 mm port was placed. A 5 mm Mersilene suture was used and tied with a posterior knot to avoid friction with bladder. Patients or Participants Only one patient was selected for this video. Interventions A laparoscopic abdominal cerclage (Benson) was placed in a patient with history of cervical cone due to a low-grade intraepithelial lesion at 22 years old. She underwent an IVF cycle due to idiopathic infertility. A frozen embryo was programmed, knowing that a cerclage needed to be placed after 12 weeks gestation. The cerclage (McDonald) was placed on an extremely short cervix (1 cm). She suffered a 2nd trimester loss due to rupture of membranes with Klebsiella positive culture. In preparation for next frozen embryo transfer, we recommended placement of an abdominal cerclage via laparoscopy. Measurements and Main Results The patient was seen after the laparoscopic procedure, with a vaginal ultrasound confirming the adequate placement of the abdominal cerclage. The patient will undergo frozen embryo transfer in the next months. Conclusion Initially, we informed the patient that, due to her gynecologic history, a cerclage was to be placed once a pregnancy reached the first trimester. We explained that given her extremely short cervix, an abdominal cerclage was needed to improve the outcome of her next frozen embryo cycle. To present the case of a patient undergoing fertility treatment, who required a Laparoscopic Abdominal Cerclage to improve fertility outcome. Descriptive video of Laparoscopic placement of Benson Cerclage. Patient was in lithotomy position during surgery. One umbilical 5 mm port was used for the camera. Two 5 mm accessory ports were placed on both lower quadrants, and a left lateral 5 mm port was placed. A 5 mm Mersilene suture was used and tied with a posterior knot to avoid friction with bladder. Only one patient was selected for this video. A laparoscopic abdominal cerclage (Benson) was placed in a patient with history of cervical cone due to a low-grade intraepithelial lesion at 22 years old. She underwent an IVF cycle due to idiopathic infertility. A frozen embryo was programmed, knowing that a cerclage needed to be placed after 12 weeks gestation. The cerclage (McDonald) was placed on an extremely short cervix (1 cm). She suffered a 2nd trimester loss due to rupture of membranes with Klebsiella positive culture. In preparation for next frozen embryo transfer, we recommended placement of an abdominal cerclage via laparoscopy. The patient was seen after the laparoscopic procedure, with a vaginal ultrasound confirming the adequate placement of the abdominal cerclage. The patient will undergo frozen embryo transfer in the next months. Initially, we informed the patient that, due to her gynecologic history, a cerclage was to be placed once a pregnancy reached the first trimester. We explained that given her extremely short cervix, an abdominal cerclage was needed to improve the outcome of her next frozen embryo cycle.