Laparoscopic Abdominal Cerclage Research Articles

Laparoscopic Abdominal Cerclage – Techniques and Troubleshooting a Gravid Uterus

Objective: The purpose of this video is to review the basic steps of a laparoscopic abdominal cerclage, compare how it is more challenging in the gravid uterus, and offer techniques for troubleshooting these challenges.

692 - Laparoscopic Abdominal Cerclage. A Simplified Approach of a Challenging Procedure

692 - Laparoscopic Abdominal Cerclage. A Simplified Approach of a Challenging Procedure

Robotic-Assisted Laparoscopic Abdominal Cerclage Placement During Pregnancy

Study ObjectiveThe objective of this study is to report our center's series of robotic-assisted laparoscopic abdominal cerclage (RALAC) placement during pregnancy. DesignDescriptive study (Canadian Task Force classification III). SettingSingle academic institution. PatientsPatients undergoing RALAC placement during pregnancy. InterventionsEleven patients underwent RALAC. Measurements and Main ResultsNine out of 11 (81.8%) primary RALAC procedures resulted in a viable live-born neonate; 8 (72.7%) were born at >34 weeks of gestation. Three patients (27.3%) had preterm premature rupture of membranes on postoperative day one, 2 of whom subsequently underwent a dilation and curettage, and 1 patient carried the pregnancy to 29 weeks and delivered a live-born neonate. Four patients had subsequent pregnancies after placement of a RALAC in the antepartum period, all of whom carried successfully beyond 36 weeks, for a total of 16 pregnancies. Fourteen pregnancies (87.5%) resulted in a live birth, and 13 pregnancies (81.3%) were delivered beyond 34 weeks. ConclusionRALAC is a minimally invasive procedure with an acceptable risk profile and comparable efficacy to traditional open abdominal cerclage. RALAC may be considered an acceptable alternative to open abdominal cerclage in pregnancy, and may be a particularly favorable option in certain settings.

422 - Laparoscopic Abdominal Cerclage: Surgical and Obstetric Outcomes of 106 Cases

Study Objective: To evaluate surgical and obstetric outcomes following laparoscopic abdominal cerclage (LAC) for the treatment of cervical insufficiency.

411 - Description of the Laparoscopic Abdominal Cervical Cerclage Technique

To describe the surgical technique of laparoscopic abdominal cervical cerclage

299 - Laparoscopic Abdominal Cerclage: Tips and Tricks

30 year old G2P0200 with a history of recurrent 2nd trimester pregnancy loss presented for abdominal cerclage prior to attempting pregnancy for a third time. Her cerclage was placed without complication. We aimed to review advantages of abdominal cerclage placement, timing of placement and tips and tricks for successful placement of a laparoscopic abdominal cerclage, based on our institution's 10 years of experience.

Laparoscopic abdominal cerclage after radical vaginal trachelectomy

The incidence of cervical cancer (CC) in Slovenia in 2011 was 13.2 per 100,000 women. The treatment of early stages of invasive cervical carcinoma involves several surgical techniques. In this article the authors would like to present a new combination of two methods which help to preserve fertility and to improve pregnancy outcome. The first procedure, radical vaginal trachelectomy (RVT), begins with laparoscopic pelvic lymphadenectomy. All suspicious lymph nodes are sent to frozen section. If those lymph nodes are negative, the procedure continues vaginally. Almost the entire cervix is removed with parametria and vaginal cuff. Permanent cerclage stitch is applied and covered with vagina on what is left of uterus. Second procedure, laparoscopic abdominal cerclage (LAC), begins with pneumoperitoneum. Mersilene tape is introduced in the abdominal cavity and placed through the visceral peritoneum at the isthmic part of the uterus with a Berci's needle. It is knotted and remains permanently. For the first procedure all the patients with confirmed cervical carcinoma (FIGO Stage IA₁, IA₂, and IB₁) and with the desire for fertility were recruited. For the second procedure, all the patients after RVT and after miscarriage after 14th week of gestation were recruited. RVT was performed in 15 patients and laparoscopic abdominal cerclage in three of them (21.5%). All three patients achieved pregnancies and after 36th weeks of gestation delivered by cesarean section (100%). RVT alone is an indication for LAC. Considering its success, LAC should be performed before any miscarriage.

Laparoscopic Abdominal Cerclage

Purpose of Review This article reviews the current state of the literature as regards to the indications, outcomes, and techniques of laparoscopic abdominal cerclage.

Needleless laparoscopic abdominal cerclage placement.

To show a technique of laparoscopic interval abdominal cerclage placement with the use of a needleless mersilene tape. Step-by-step explanation of the technique using a surgical video. Cervical insufficiency affects 1% of all pregnancies and up to 8% of those with second and early third trimester losses. The abdominal method has been used in patients with an extremely short cervix in whom the transvaginal approach is not technically possible or for those who have experienced an unsuccessful transvaginal procedure. With the introduction of the transabdominal cerclage, the fetal survival rate improved from 21% to 89%. In an attempt to decrease the surgical morbidity associated with laparotomy, there have been multiple case series and cohort studies in the literature that described the laparoscopic approach for transabdominal cerclage placement. Laparoscopic abdominal cerclage placement was performed as an interval procedure using needleless mersilene tape after meticulous skeletonization of the uterine vessels and formation of the peritoneal window. Laparoscopic abdominal cerclage was placed without any complications, providing the patient with the benefits of minimally invasive approach. The risk of bleeding was reduced by meticulous dissection and skeletonization of uterine vessels and eliminating the use of the mersilene tape needle.

Needleless Laparoscopic Abdominal Cerclage Placement

Patient was a 30 yo G2P0020 with cervical incompetence who failed vaginal cerclage in her prior pregnancy. She was referred for laparoscopic abdominal cerclage placement as an interval procedure.

Two Live Births following Robotic-Assisted Abdominal Cerclage in Nonpregnant Women

Introduction. To report the robotic-assisted abdominal cerclage performed in two nonpregnant women and the success of live birth outcomes. Presentation of Cases. A 36-year-old woman with a complaint of recurrent second trimester pregnancy losses and a 35-year-old patient with a complaint of preterm deliveries and cervical insufficiency underwent robotic assisted abdominal cervicoisthmic cerclage placement in nonpregnant period. The two patients had spontaneous pregnancy after the robotic-assisted abdominal cerclage and delivered healthy infants. Discussion. The limitations of traditional laparoscopic abdominal cerclage have been accomplished with robotic surgery advantages especially intuitive movements and increased range of motion. There are only a few studies in the literature including robotic assisted abdominal cerclage in nonpregnant women, and only five successful live birth outcomes were reported. In this paper, we reported the sixth and seventh cases of achieved live pregnancy after robotic assisted abdominal cerclage in the literature. Conclusion. Robotic assisted abdominal cerclage is a good alternative surgical method with successful pregnancy outcomes.

Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study

To evaluate the effect of laparoscopic abdominal cerclage performed as an interval procedure in non-pregnant women at high risk of second trimester spontaneous abortion and early preterm birth. Observational study. Fifty-two consecutive patients at high risk of preterm birth. Department of Obstetrics and Gynecology, Aarhus University Hospital. Patients were registered prospectively. Indications for surgery included classical cervical insufficiency, preterm premature rupture of membranes (PPROM) or two conizations/cervical amputation. Outcome of subsequent pregnancies was registered. Gestational age in subsequent pregnancies. No operative or postoperative complications were observed. A total of 45 pregnancies were registered during the observation period. Among 36 pregnancies lasting beyond the 16th week of gestation, 30 women (83.3%) gave birth by cesarean section after 36 weeks of gestation and the overall mean gestational age was 37.4 weeks compared with a mean gestational age of 25.2 weeks of the pregnancies prior to the cerclage. The cesarean sections were uncomplicated in all but one patient, where a re-laparotomy was needed six hours later due to atonic postpartum hemorrhage without evident bleeding through the cervix. Laparoscopic abdominal cerclage is a feasible and safe procedure. Obstetrical outcomes are encouraging but prospective studies are needed to define the effectiveness of the laparoscopic cerclage compared with the traditional transvaginal approach.

Autumn advances towards 2013

Autumn advances towards 2013

Laparoscopic Abdominal Cerclage in a Postoperative Pelvis

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.

P32.08: Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study

P32.08: Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study

Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study

The purpose of this study was to evaluate the effectiveness of laparoscopic abdominal cerclage placement in the prevention of recurrent preterm birth. We conducted a multicenter cohort study with retrospective Dutch (32 patients) and Boston (34 patients) cohorts who had undergone preconceptional laparoscopic abdominal cerclage placement. Eligible patients had at least 1 second/third trimester fetal loss or delivered at <34 weeks of gestation because of cervical insufficiency and/or a short or absent cervix. Primary outcome was delivery of an infant at ≥ 34 weeks of gestation with neonatal survival. Secondary outcome measures included surgical and pregnancy outcomes and patients' satisfaction (Dutch cohort). Surgical outcomes of 66 patients were excellent, with 3 minor complications. After preconceptional laparoscopic abdominal cerclage, 35 pregnancies were evaluated. Twenty-five patients (71.4%) delivered at ≥ 34 weeks of gestation; 3 patients (8.6%) experienced a second-trimester fetal loss. The total fetal survival rate was 90.0%. Preconceptional laparoscopic abdominal cerclage shows encouraging and favorable perinatal outcomes in patients with a poor obstetric history.

Repeat Transabdominal Laparoscopic Encerclage

ABSTRACTWe report here the first case of placement of a repeat laparoscopic abdominal cervicoisthmic cerclage by using a suture passer. The report is on a 34-year-old G5P1L1A3with a history of repeated second trimester pregnancy loss with one successful laparoscopic cerclage term LSCS delivery, again underwent repeat laparoscopic abdominal encerclage in present pregnancy at 12 weeks using suture passer suprapubically. Patient underwent procedure safely with blood loss less than 40 ml and discharged after 24 hours of observation without any postoperative complication. Repeat laparoscopic abdominal encerclage can be done safely in previous LSCS patient who had term pregnancy following laparoscopic abdominal cerclage using a simple instrument suture passer without any postoperative complication or discomfort to the patient.

Laparoscopic Abdominal Cerclage Placed at 14 Weeks Gestation

Laparoscopic Abdominal Cerclage Placed at 14 Weeks Gestation

Technique to reduce complexity and improve safety of laparoscopic cervical cerclage, case series

Abdominal cerclage is a management option for patients with diagnosis of cervical incompetence and impossible or recurrent failure of vaginal cerclage. Impossible vaginal route is seen in patients with previous...

A good blend of interesting topics

As you receive this April issue the scent of spring is already in the air in the southern part of the Nordic countries, let alone more southerly parts of Europe, while further north we are still en...