Total Laparoscopic Cervical Encerclage in 16 Weeks Pregnant Uterine Didelphis Uterus Category: Laparoscopy

Abstract

Study Objective To demonstrate Laparoscopic approach for encerclage in pregnancy in a ℅ uterine didelphys. Design A case report. Setting laparoscopy surgery with patient in lithotomy position under anaesthesia. Patients or Participants A 26-year-old female came G3 A2 with previous 2- 2nd trimester abortions with failed vaginal encerclage and uterine didelphys diagnosed on MRI with 16 weeks pregnancy. Interventions Laparoscopic cerclage was planned using Mersilene tape. Measurements and Main Results Cervical insufficiency (CI) or incompetence is a well-known condition in obstetrics with an incidence of 0.1–1% and is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. The traditional surgical treatment for cervical insufficiency consists of vaginal placement of cervical stitches, known as transvaginal cervical cerclage (TVC). Advances in the field of minimally invasive surgery resulted in development of a new approach to cervical cerclage placement. Laparoscopic cerclage offers the benefit of reduced blood loss, reduced postoperative pain, and fewer adhesions, as well as decreased length of hospital stay and overall faster recovery time. Principles of surgery: 1. Dissection of loose UV fold of peritoneum. 2. Creation of window in the broad ligament on both sides. 3. Passing the needle of mersilene tape from medial to the uterine artery of left side at the level of internal os. 4. Passing the Mersilene tape all around the uterus 5. Passing the needle of mersilene tape from medial to uterine artery on right side. 6. Tightening the mersilene tape at the level of the internal os. Conclusion Similar to the transabdominal approach, laparoscopic cerclage can be placed during pregnancy or as an interval procedure. Success rates for laparoscopic cerclage were reported in the range of 76% to 100%. To demonstrate Laparoscopic approach for encerclage in pregnancy in a ℅ uterine didelphys. A case report. laparoscopy surgery with patient in lithotomy position under anaesthesia. A 26-year-old female came G3 A2 with previous 2- 2nd trimester abortions with failed vaginal encerclage and uterine didelphys diagnosed on MRI with 16 weeks pregnancy. Laparoscopic cerclage was planned using Mersilene tape. Cervical insufficiency (CI) or incompetence is a well-known condition in obstetrics with an incidence of 0.1–1% and is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. The traditional surgical treatment for cervical insufficiency consists of vaginal placement of cervical stitches, known as transvaginal cervical cerclage (TVC). Advances in the field of minimally invasive surgery resulted in development of a new approach to cervical cerclage placement. Laparoscopic cerclage offers the benefit of reduced blood loss, reduced postoperative pain, and fewer adhesions, as well as decreased length of hospital stay and overall faster recovery time. Principles of surgery: 1. Dissection of loose UV fold of peritoneum. 2. Creation of window in the broad ligament on both sides. 3. Passing the needle of mersilene tape from medial to the uterine artery of left side at the level of internal os. 4. Passing the Mersilene tape all around the uterus 5. Passing the needle of mersilene tape from medial to uterine artery on right side. 6. Tightening the mersilene tape at the level of the internal os. Similar to the transabdominal approach, laparoscopic cerclage can be placed during pregnancy or as an interval procedure. Success rates for laparoscopic cerclage were reported in the range of 76% to 100%.