Laparoscopic cerclage – an effective method of treating cervical insufficiency

Abstract

Laparoscopic transabdominal cerclage is becoming the preferred method of treating patients with repeated cases of preterm birth due to cervical insufficiency. This technique reduces the frequency of miscarriages in the second trimester and is an effective prevention of premature birth. This work analyzes modern techniques of applying serclage through transabdominal access: laparotomic, laparoscopic and robot-assisted using the da Vinci® device. Taking into account the advantages and disadvantages of each of these approaches, in clinical practice, preference should be given to the laparoscopic approach, since it is the safest (in terms of blood loss, risk of miscarriage, thrombosis of the veins of the lower extremities, as well as the cosmetic effect and hospital stay) and effective method of treating cervical insufficiency in repeated miscarriages (the frequency of childbirth in the full-term period after this operation is from 82% to 86%). Transabdominal serclage can be applied prophylactically in patients with repeated miscarriages and cervical insufficiency, transabdominal serclage does not have a negative effect on fertility. A promising operation using the da Vinci® device is inferior to the traditional laparoscopic approach, since it greatly exceeds it both in terms of the duration of the operation and in terms of cost, while having comparable efficiency. The option of highly effective treatment using minimally invasive methods suggests that laparoscopic transabdominal cerclage will become the standard of treatment for refractory isthmic-cervical insufficiency. This review examines the literature regarding the indications and results of laparoscopic cerclage.