Surgical Tips for Robotic Transabdominal Cerclage Placement

Abstract

<h3>Study Objective</h3> The objective of this video is to present indications for an abdominal cerclage placement, review the steps of a robotic abdominal cerclage, surgical variations in the procedure, and different instruments used. <h3>Design</h3> Surgical Video. <h3>Setting</h3> The operative room. <h3>Patients or Participants</h3> We present two cases of patients who were referred from Maternal Fetal Medicine for robotic abdominal cerclage placement. The first patient was a 31-year-old G11P0290 who had a known history of cervical incompetence. She had a history of several second trimester fetal loss despite having a vaginal cerclage attempted twice. The second patient is a 40-year-old G3P1021 with a history of a 19-week spontaneous vaginal delivery followed by a 20-week vaginal delivery after a failed vaginal cerclage placement at 13 weeks. <h3>Interventions</h3> Surgical management. <h3>Measurements and Main Results</h3> Both patients underwent placement of a robotic abdominal cerclage with 1 cm Mersilene tape. Two different surgical techniques for tape placement are presented in each patient case. The first case demonstrates passage of a blunted needle while the second case demonstrates tunneling with passage of the tape. <h3>Conclusion</h3> Robotic abdominal cerclage placement is an effective procedure for treatment of cervical incompetence when indicated. There are a number of variations in surgical technique which are discussed in this video. We review tunneling with Mersilene tape versus passage of Mersilene tape on a blunted needle.