Laparoscopic Abdominal Cerclage in a Postoperative Pelvis

Abstract

This video features a laparoscopic abdominal cerclage in the setting of dense anterior adhesions. The patient is a thirty-six year old woman whose two term deliveries have both been cesarean. The second, following a second trimester loss, required a transvaginal cerclage. Her next transvaginal cerclage failed, resulting in a twenty-two week loss. Given this history, she required an abdominal cerclage. Another laparotomy might have increased the morbidity of her desired third cesarean delivery. Extensive laparoscopic adhesiolysis utilizing intermittent backfilling of the bladder skeletonized the anatomy without injuring the uterus or its support structures.