Laparoscopic Cerclage during Pregnancy

Abstract

<h3>Study Objective</h3> The objective of this study is to demonstrate techniques for successful placement of laparoscopic cerclage in pregnancy, highlighting ways to mitigate the challenges of operating on the gravid uterus, and differences from the procedure performed outside of pregnancy. <h3>Design</h3> Video case presentation illustrative of techniques for laparoscopic cerclage in pregnancy. <h3>Setting</h3> Quaternary care academic hospital <h3>Patients or Participants</h3> 34-year-old with two prior preterm deliveries in the setting of cervical insufficiency, a prior failed vaginal cerclage, and currently 13 weeks gestation. <h3>Interventions</h3> Laparoscopic abdominal cerclage placement. <h3>Measurements and Main Results</h3> The patient had an uncomplicated pregnancy following her laparoscopic cerclage, delivering at 37 weeks by cesarean following spontaneous rupture of membranes. <h3>Conclusion</h3> There are important differences between laparoscopic placement of a cerclage outside of pregnancy and during pregnancy. For the latter, the uterus is more difficult to manipulate, the vessels are larger and more fragile, and the risk of pregnancy loss exists. Creating windows in the broad ligaments helps identify the correct location for cerclage placement and avoid injury to the uterine vessels. An anterior-to-posterior on the left, followed by posterior-to-anterior approach on the right allows for ergonomic needle handling using two 5-mm right-sided ipsilateral ports.