Mersilene Tape Research Articles

A comparison of Mersilene tape versus braided suture in transvaginal cervical cerclage: A retrospective case-control study.

Previous studies have indicated that there is an association between cervical cerclage and type of suture material. However, it is still unclear which suture material can provide the greatest benefit to patients who have undergone cerclage. This study investigated the effect of two different suture materials (Mersilene tape vs braided suture) used for transvaginal cervical cerclage placement on maternal outcomes of women with cervical insufficiency. In this retrospective case-control study, 170 women who underwent history-, ultrasound-, or physical examination-indicated transvaginal cervical cerclage were categorized according to suture materials used for cerclage: a total of 96 received Mersilene tape and 74 received braided suture. Study participants received a transvaginal cervical cerclage before 28 weeks and were followed up until delivery to assess pregnancy and neonatal outcomes. The primary outcome was gestational age at delivery. Secondary outcomes included preterm premature rupture of membranes (PPROM), premature rupture of membranes (PROM), chorioamnionitis, neonatal survival rate, and neonatal morbidity. Out of 170 eligible women, 74 (43.5%) received braided suture while 96 (56.5%) received Mersilene tape. Baseline characteristics were similar between the two groups. The group that received braided suture had a lower incidence of gestational age at delivery <37 weeks (29.2% vs 54.2%, P = 0.046), PPROM (9.5% vs 21.9%, P = 0.029) and PROM (17.6% vs 32.3%, P = 0.028) compared to the group that received Mersilene tape. However, there were no significant differences between the two groups in average gestational age at delivery, the rate of gestational age at delivery <24, <28, <32, and < 34 weeks, chorioamnionitis, and neonatal survival rate, as well as neonatal morbidity. Compared to Mersilene tape, the utilization of braided suture has been significantly associated with a reduction in the incidence of gestational age at delivery <37 weeks, as well as a decreased risk of PPROM and PROM. However, the use of braided sutures did not result in discernible differences in the rates of chorioamnionitis or adverse neonatal outcomes.

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

Mersilene tape versus conventional sutures in transvaginal cervical cerclage: a systematic review and meta-analysis

ObjectiveThis study aimed to assess the effectiveness of Mersilene tape versus alternative suture types in prolonging singleton pregnancies as well as other pregnancy and neonatal outcomes, in cases of history-, ultrasound-, and exam-indicated cervical cerclage.MethodsA systematic review was conducted to identify relevant studies comparing different suture types in cervical cerclage procedures. The primary outcome of interest was preterm birth (PTB) rate < 37, <35, < 28, and < 24 weeks. Statistical analyses were performed to determine the relationship between suture type and various outcomes.ResultsA total of five studies, including three randomized controlled trials (RCTs) and two retrospective studies, with a combined participation of 2325 individuals, were included. The pooled analysis indicated no significant association between suture type and PTB at less than 37 weeks of gestation (RR: 1.02, 95% CI: 0.65–1.60, p < 0.01, I2 = 74%). Women who received Mersilene tape had a higher risk of PTB at 34–37 weeks (RR: 2.62, 95% CI: 1.57–4.37, p = 0.69, I2 = 0%), but a lower risk of PTB at less than 34 weeks (RR: 0.43, 95% CI: 0.28–0.66, p = 0.66, I2 = 46%). No statistically significant differences were observed for PTB before 28 weeks (RR: 1, 95% CI: 0.65–1.53, p = 0.70, I2 = 0%), before 24 weeks (RR: 0.86, 95% CI: 0.60–1.23, p = 0.33, I2 = 0%), incidence of chorioamnionitis (RR: 0.97, 95% CI: 020-4.83, p < 0.01, I2 = 95%), neonatal intensive care unit (NICU) admission (RR: 0.79, 95% CI: 0.28–2.22, p = 0.08, I2 = 67%) and neonatal death (RR: 1.00, 95% CI: 0.42–2.35, p = 0.17, I2 = 48%).ConclusionOur findings suggest that Mersilene tape does not reduce the risk of PTB before 37, 28 or 24 weeks. We observed higher risk of preterm birth between 34 and 37 weeks with Mersilene tape but lower incidence before 34 weeks, a period with higher neonatal morbidity and mortality. Due to the limited number of studies, our results and their clinical significance should be interpreted with caution.

O-055 Efficacy of Laparoscopic Abdominal Cerclage in Women With Prior 2nd Trimester Losses/Preterm Birth: Perinatal Outcomes of Case Series

Abstract Study question What is the efficacy of laparoscopic abdominal cerclage (LAC) that placed during periconceptional period in singletons with prior 2nd trimester pregnancy losses/preterm deliveries (PTDs)? Summary answer LAC seems to prolong pregnancy duration and enhance perinatal outcomes in singletons prior 2nd trimester losses/PTDs. What is known already Cervical insufficiency (CI) is defined as the inability of the uterine cervix to retain a pregnancy till term without the signs and symptoms of clinical contractions ,with an incidence up to 1% (Berghella, 2011). Cervical cerclage (CC) has been proposed as an effective treatment for CI in terms of successfully prolonging the pregnancy period and improving the perinatal prognosis. The common clinical approach is transvaginal cervical cerclage (TVC), which is a feasible and relatively easy technique. However, some group of women may experience late abortions and/or PTD and LAC has been proposed to enhance pregnancy outcomes. Study design, size, duration Case series consisting of singletons with at least 2 prior PTDs and managed with LAC was reviewed between January 2019-November 2022. After placement of LAC, reproductive and perinatal outcomes of women were reviewed for 2 years. Participants/materials, setting, methods All women with at least 2 prior 2nd trimester losses and/or PTDs were offered to LAC procedure during the period. After having informed consents, total of 28 LAC procedures were performed. All surgeries were performed by a single experienced laparoscopist in the same center. Non-absorbable mersilene tape was placed during preconceptional period. Reproductive outcomes including spontaneous and assisted conception cycles and perinatal outcomes were reported. Main results and the role of chance A total of 28 LAC proceudres were performed during the period. Mean age of women was 34±2 and mean numbers of previous 2nd trimester losses/PTDs was 2.8±0.8, of which all of them were &amp;lt;24 weeks. Total of 8 women have had gynecologic surgery in their history. Less than 12 months interval, 19 out of 28 women got pregnent; 13/28 conceived spontaneously and 6/28 conceived with after IVF treatment. For the perinatal outcomes; there were no single case of 2nd trimester losses/PTDs &amp;lt;24 weeks in the entire cohort. 15 women delivered &amp;gt;34 weeks and remaining 4 delivered at term (&amp;gt;37 weeks). During the gestation, no additional medication was provided to pregnants such as progesterone treatment. The mean gestational age was 35 4/7 weeks. There were no remarkable adverse events during the pregnancy. All newborns were healthy without remarkable issues, only 2 infants required intensive care for less than 2 weeks. Limitations, reasons for caution Small sample size, lack of a control group and randomization and heterogenious patient population. Wider implications of the findings LAC appears to have favorable pregnancy outcomes in singletons with prior pregnacy losses and/or PTDs. To precisely conclude, randomized controlled trials are needed with different intervention arms in the same population. Trial registration number non applicable

Effect of Suture Material in History-Indicated Cerclage on Spontaneous Preterm Delivery Risk [ID: 1370506

INTRODUCTION: This study aimed to determine whether suture material in history-indicated cerclage is associated with spontaneous preterm delivery (sPTD). METHODS: We conducted a retrospective cohort study of patients with singleton pregnancies who underwent history-indicated transvaginal cerclage at a tertiary care center from June 2015 to January 2022. The primary outcome was sPTD before 24 weeks of gestation. Secondary outcomes included sPTD at less than 26, 28, 32, and 34 weeks of gestation, chorioamnionitis, days in neonatal intensive care unit, and various adverse neonatal outcomes. Baseline characteristics and outcomes were compared using chi-square and Fisher’s exact tests according to type of suture material: 5-mm braided polyester fiber (Mersilene tape) versus monofilament suture (Prolene). Odds ratios (ORs) for sPTD were estimated using multivariable logistic regression. RESULTS: A total of 64 patients were included in the study, with 50 (78%) patients receiving Mersilene and 14 (22%) receiving Prolene. Mersilene, compared to Prolene, was associated with significantly lower rates of sPTD at less than 24 weeks (6% versus 29%, P=.02) and less than 26 weeks (8% versus 29%, P=.04). At more advanced gestational ages, Mersilene still resulted in lower rates of sPTD compared to Prolene, but statistical significance was lost. After adjusting for race and ethnicity, body mass index, use of postoperative progesterone, and gestational age at cerclage placement, patients with Prolene had increased odds of delivery less than 24 weeks (OR 7.69, 95% CI 1.04–56.6). Secondary outcomes were similar between the two groups. CONCLUSION: In patients undergoing history-indicated cerclage, Mersilene compared to Prolene was associated with a significantly lower risk of previable pregnancy loss.

Cervical cerclage technique: what do experts actually achieve?

Cervical cerclage is a recognised intervention in the management of women who are at risk of preterm birth and mid-trimester loss. The mechanism of action of cerclage is unclear and the technique has been poorly researched. We aimed to evaluate cerclage technique amongst experienced obstetricians, using a cerclage simulator we previously developed and evaluated. This prospective experimental simulation and observational study used identical simulators for 28 Consultant Obstetricians who were asked to perform their normal cerclage. Suture type, height, knot site and free thread length were recorded. Using computerised tomography, depth of bite and tension (by reduction in area of cervix) were calculated. Fifty-two cervical cerclages were completed (Mersilene tape n=20, monofilament suture n=32). Mean suture height was 33mm (SD 7.7mm) and was greater with monofilament suture than Mersilene tape and was associated with smaller needle size. Mean depth of bite and mean reduction of starting area did not differ by suture type. Seven procedures showed one or more suture bites that had entered the cervical canal once or more. In the first study of cerclage technique by experienced obstetricians using simulator and CT imaging we demonstrate wide variation in technique; this may affect the efficacy of the procedure. Further work should include establishing optimal technique and a consensus agreed for training and clinical practice.

Cervical cerclage vs pessary in women with a sonographic short cervix.

In the present study we sought to compare the efficacy of cervical pessary to that of cerclage in terms of reducing preterm birth rates among women with a short (<25 mm) and ultra-short (<15 and <10 mm) cervix during the ultrasonographic second trimester assessment. We retrospectively searched the hospital records for singleton pregnancies diagnosed with cervical insufficiency during the second trimester of pregnancy. The McDonald cerclage was used in all women with the use of a 5mm Mersilene tape. Arabin pessary was used uniformly. In all cases 80 mg of vaginal progesterone gel was administered daily, until 37 weeks of gestation. Overall, 294 women were selected for analysis of whom 124 (42.2%) had a McDonald cerclage and 170 (57.8%) had placement of an Arabin pessary. Preterm birth rates <37 weeks were similar in both groups (C: 30/122 vs P: 35:165, p=.581) as well as PTB <34 weeks (C: 16/122 vs 15/150, p=.278). Admission to the NICU and need for CPAP were more prevalent in the cerclage group (p<.001). Analysis of cases with a cervix <15 mm and <10 mm indicated that preterm birth rates remained equal among groups whereas an increased risk of NICU admission in cases with cervical length <10 mm that were treated with cerclage. Cervical pessary may be an alternative to cervical cerclage for women with second trimester cervical shortening and its effect may persist even among cases with an ultra-short cervix. Future randomized trials are needed to ascertain these findings.

Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial

Importanceuterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objectivecompare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. ResultsHigh statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). ConclusionsUsing Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Comparación entre el uso de malla de prolene y cinta de mersilene en la sacrohisteropexia abdominal para el prolapso apical: ensayo clínico aleatorizado

BackgroundUterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. ObjectiveCompare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ?? or more. Study designThis RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned sacrohysteropexy for uterine prolapse≥stage 2 assigned to 2 groups: Mesh group (n=38), underwent sacrohysteropexy with polyproline mesh, and tape group (n=38), underwent sacrohysteropexy using mersilene tape. ResultsHigh statistically significant difference between tape group and mesh group concerning hysteropexy time was 50.4minute in tape group vs 90.6minute in mesh group (P<.001), need for post operative analgesia was 14 in tape group vs 27 in mesh group (P<.005). The mean hospital stay was 2.8 days in tape group vs 5.2days mesh group (P<.001). ConclusionsUsing mersilene tape in sacrohysteropexy is a safe alternative to polyproline mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

The Cx Device: Benchtop Testing of a Medical Device to Treat Cervical Insufficiency

A cerclage prevents preterm birth, in part, by compressing the cervix and preventing preterm dilation. However, a cerclage does not prevent preterm birth in all cases and adverse effects can occur. To address the limitations of a cerclage, a proof-of-principle, medical device was designed. Like a cerclage, the device uses a suture to apply compression. Unlike a cerclage, the suture applies compression to polymer plates, which compress the tissue (Figure). Thus, compression forces are distributed over a larger tissue contact area. Called the Cx Device (CxD), our objective was to compare the CxD to a cerclage suture in benchtop tests of 1) cervical laceration and 2) ultrasound-derived cervical length. To simulate a cervical laceration, a previously described silicone cervix model was used. Mersilene tape was sutured to the silicone cervix. The suture was pulled through the silicone until material failure was observed. For the CxD, a polymer plate was sutured to the silicone cervix model and pulled through until failure was observed. The peak load at failure was measured for the Mersilene and the CxD polymer plate (n=5 replicates). To simulate ultrasound-derived cervical length, a custom, cervix-shaped, ultrasound phantom was constructed using Zerdine hydrogel (CIRS). The inside canal of the ultrasound phantom formed a funnel to simulate a short, dilated cervix. A Mersilene cerclage vs. CxD was installed on the ultrasound phantom. The ultrasound phantom was attached to a cerclage simulator (Limbs and Things, Model 80180) and cervical length was measured with a vaginal probe (n=3 replicates) (Philips 3D9-3V). The peak load at failure of the silicone cervix was significantly higher for the CxD compared with Mersilene (166 Newtons vs. 73 Newtons, p< 0.001). Compared to Mersilene, the closed cervical length was 0.6 cm longer when the CxD was installed (p< 0.01) The CxD compresses the cervix over a larger contact area, which significantly decreased laceration risk and improved cervical length in benchtop testing.

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

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%.

Surgical Tips for Robotic Transabdominal Cerclage Placement

<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.

Robotic-Assisted vs Conventional Laparoscopic Transabdominal Cerclage Placement

<h3>Study Objective</h3> To compare and contrast robotic-assisted versus laparoscopic transabdominal cerclage placement. <h3>Design</h3> Video. <h3>Setting</h3> Tertiary academic medical center with two minimally-invasive gynecologists. <h3>Patients or Participants</h3> Two patients at approximately 13 weeks gestation with cervical insufficiency. <h3>Interventions</h3> Transabdominal cerclage. <h3>Measurements and Main Results</h3> It is important to know useful tools in placement of minimally invasive transabdominal cerclage. These include the 30-degree laparoscope, sacrocolpopexy cup, uterine manipulators, and laparoscopic paddle retractor. Consider use of a suprapubic port for laparoscopic cerclage placement for more ideal angle for dissection of the avascular tunnel and passage of the Mersilene tape. Tying the Mersilene tape anteriorly laparoscopically can be helpful so that no additional port is used for manipulation of the uterus. <h3>Conclusion</h3> Transabdominal cerclage may be placed safely in a minimally invasive fashion both with robotic-assisted and conventional laparoscopic approach.

Laparoscopic Abdominal Cerclage after Prior Radical Trachelectomy

<h3>Study Objective</h3> To present a case and surgical video of laparoscopic abdominal cerclage placement after prior radical trachelectomy and demonstrate techniques in overcoming challenging dissections and an alternative surgical technique in placement of cerclage. <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> In the operating room with a patient in dorsal lithotomy position with both arms tucked. A 10mm port was placed at the umbilicus and 3 additional 5mm ports were placed in the right and left lower quadrant and suprapubic region. A uterine manipulator, flexible laparoscopic, and bipolar sealing device were used. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> A 34yo P2 with prior surgical history of exploratory laparotomy, radical trachelectomy, sentinel lymph node mapping, pelvic lymphadenectomy for stage 1B1 cervical squamous cell cancer. She had been disease free for two years and she had erosion of her vaginal cerclage that had been placed at the time of her original surgery. She had two prior cesarean deliveries prior to her cervical cancer diagnosis and desired future fertility. She underwent a laparoscopic abdominal cerclage with cystoscopy and ureteral catheter placement. <h3>Measurements and Main Results</h3> Laparoscopic placement of abdominal cerclage was successful. Surgical techniques in navigating difficult dissections are reviewed in the video. In the absence of a cervicouterine junction, placement a 5mm Mersilene tape cerclage at the neo-cervical region was successful. There were no intra or post-operative complications. Patient had a good surgical recovery. <h3>Conclusion</h3> This video demonstrates challenges in placement of an abdominal cerclage following a radical trachelectomy due to distortion of anatomy and dense post-surgical adhesions. The video demonstrates that laparoscopic placement at the neo-cervical junction can be accomplished successfully and safely.

Clinical and radiologic outcomes of the modified phemister procedure with coracoclavicular ligament augmentation using mersilene tape versus hook plate fixation for acute acromioclavicular joint dislocation

BackgroundThe clinical superiority of surgical treatment for acromioclavicular (AC) joint dislocation remains controversial. The aim of this study was to compare the clinical and radiological outcomes of the modified Phemister procedure with CC ligament augmentation using Mersilene tape to those of hook plate fixation for acute AC joint dislocation.MethodsIn this study, patients who received modified Phemister surgery with CC ligament augmentation using Mersilene tape (PM group) or hook plate fixation (HK group) for acute unstable AC joint dislocation with a minimum 5-year follow-up period were retrospectively reviewed. The clinical outcomes were evaluated according to blood loss during surgery, surgical duration, visual analogue scale (VAS), Constant-Murley score (CMS), University of California at Los Angeles (UCLA) shoulder rating scale, and the occurrence of complications. Radiological outcomes were assessed from radiographs according to multiple parameters, including CC distance maintenance, acromion osteolysis, and the presence of distal clavicle osteolysis.ResultsA total of 35 patients completed follow-up for more than 5 years and were analyzed in this study (mean = 74.08 months). There were 18 patients in the PM group and 17 in the HK group. The PM group exhibited similar improvement in functional outcome to the HK group. Regarding radiological outcomes, the HK group had a superior performance in terms of CC distance maintenance, of statistical significance (CCDR: 94.29 ± 7.01% versus 111.00 ± 7.69%, p < 0.001) after a one-year follow-up period. However, there were 4 cases of acromion osteolysis and 2 cases of distal clavicle osteolysis in the HK group.ConclusionHook plate fixation was found to be superior to the modified Phemister technique with CC ligament augmentation using Mersilene tape in terms of CC distance maintenance, but there was no significant difference in the functional outcome after 5 years of follow-up. Both surgical methods are reliable options for the treatment of acute AC joint dislocation. Modified Phemister surgery with CC ligament augmentation using Mersilene tape is a relatively lower-cost option for acute AC joint dislocation without the need of a second surgery for implant removal.

A stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage

To propose a stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage. A narrated video footage of the surgical approach of a clinical case with extensive adenomyosis and recurrent abortions. Institutional review board approval was obtained (No 3.725.458). A university center. We present a case of a 37-year-old patient, gravida 4 para 0 with a history of 3 first trimester miscarriages after spontaneous pregnancies, and a 20-week spontaneous abortion after an invitro fertilization pregnancy. She underwent 2 laparoscopic excisions of deeply infiltrative endometriosis and was treated with gonadotropin-releasing hormone for 6 months and dienogest for a year with no improvement of her adenomyosis. Currently, she experiences moderate dysmenorrhea and desires future fertility. For 3 months, gonadotropin-releasing hormone analogues were used before performing the robotic surgery for adenomyosis resection and abdominal cerclage. (Step 1) Control the blood supply with a tourniquet placed lateral to the uterine arteries at the level of the internal cervical os, and a diluted solution of vasopressin 20% is administered at the area to be excised. (Step 2) Uterine incision: we use a vertical uterine incision with monopolar scissors, extended anteriorly and posteriorly. (Step 3) Resection of adenomyosis: carried with monopolar scissors using pure cut current. It is recommended that 0.5-1 cm of the myometrium is maintained around the uterine cavity as well as the serosa. (Step 4) Flap 1: interrupted sutures with vicryl 2.0 are used to approximate the inner myometrium close to the endometrial cavity, and a 2.0 barbed suture is used to approximate the inner myometrium of the contralateral side of the incision to the ipsilateral outer myometrium. (Step 5) Flap 2: another 2.0 barbed suture is used to approximate the outer myometrium of the contralateral side to the base of the repaired inner myometrial layer. (Step 6) Serosal closure: the serosa is approximated with a barbed suture in a baseball fashion before the tourniquet is released and hemostasis is ensured. (Step 7) Abdominal cerclage: a mersilene tape is placed medial to the uterine arteries at the level of the internal cervical os and a tape is tied anteriorly. Description of a stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage. The operating time was 255 min with minimal estimated blood loss (250ml). She was discharged with no complaints. Three months postoperatively, dysmenorrhea significantly improved, and the magnetic resonance imaging showed a good anatomic result. An embryo transfer is planned at 6 months postoperatively. A minimally invasive approach to fertility-sparing management of diffuse adenomyosis is safe and feasible with good anatomical results. However, it should be noted that after the removal of uterine adenomyosis, the patient should be advised on the high risk of uterine rupture during pregnancy. Robotic cerclage may also be performed concomitantly in cases of 2nd-trimester recurrent abortions.

Reconstruction of the coracoclavicular ligament with palmaris longus tendon and Mersilene tape for acromioclavicular dislocations

BackgroundAcromioclavicular (AC) joint dislocation is common among shoulder injuries, and various surgical methods have been introduced for effective ligament reconstruction. Reconstruction of the coracoclavicular (CC) ligament in the anatomical position using autologous tendons is a recent surgical trend. This study is to report clinical and radiologic results of reconstruction of the CC ligament using an autologous palmaris longus tendon interweaved with Mersilene tape (PLMT) with a minimum 2-year follow-up.MethodsThis retrospective study analyzed 76 patients (mean age, 43.4 ± 11.2 years) with AC joint dislocation treated by reconstruction of the CC ligament with PLMT, from March 2004 to February 2017. The mean follow-up period was 28 ± 6.7 months (range, 24–66 months). The Visual Analog Scale (VAS) for pain assessment, American Shoulder and Elbow Surgeons rating scale (ASES), and Constant Score (CS) were used to evaluate clinical outcomes at the preoperative and the final follow-ups. CC and AC distances were measured using anteroposterior (AP) X-ray preoperatively and at the final follow-up for radiologic outcomes. Complications were also assessed.ResultsThe mean preoperative VAS for pain, ASES, CS were 5.7 ± 0.7, 77.1 ± 6.2, and 61.5 ± 5.2, respectively. These scores at the final follow-up improved to 2.1 ± 0.5, 90.9 ± 4.3, and 94 ± 7.0, respectively (p = 0.043, p < 0.001, p < 0.001). The mean preoperative CC and AC distances were 16.49 ± 3.73 mm and 13.84 ± 3.98 mm, respectively. The final follow-up CC and AC distances were 9.29 ± 2.72 mm and 5.30 ± 2.09 mm, respectively (p < 0.001, p < 0.001). Although a slight re-widening of the CC distance occurred in 10 patients (13.1%), most patients regained full range of motion of the affected shoulder at the final follow-up.ConclusionThe CC ligament reconstruction with PLMT for the treatment of AC joint dislocation showed good clinical and radiological results. This technique could be a good alternative treatment for AC dislocations.

Laparoscopic abdominal cerclage during pregnancy: a simplified approach

Cervical insufficiency is a major cause of second-trimester pregnancy loss and spontaneous preterm delivery. Transabdominal cervicoisthmic cerclage is usually performed before pregnancy for patients of cervical insufficiency, in whom transvaginal cervical cerclage procedure cannot be placed or has failed previously. Performing a transabdominal cerclage becomes a huge challenge owing to the enlargement of the pregnant uterus in patients who were indicated for transabdominal cervicoisthmic cerclage but were missed before pregnancy. Here, we have outlined an easy and effective surgical procedure as needle-free laparoscopic trans-broad-ligament cervicoisthmic cerclage during early second-trimester. Laparoscope with 4 trocars was established, after expanding the trigonum of ureter, ovarian vascular and ascending branch of uterine artery. The needleless Mersilene tape was inserted in a posterior-to-anterior direction of bilateral trigonums, tightening the knot toward the bladder uterine reflection and simultaneously pushing the loop behind the uterus, directed to the cervix progressively. The tape was then tied anteriorly at the cervico-isthmic junction with 5 to 6 intracorporeal square knots after transvaginal ultrasound determined the presence of systolic velocity of uterine artery with first knot. The primary feature of our procedure was that the needleless Mersilene tape was inserted centrally from the broad ligaments, lateral to the uterine vessels, and finally tied above the uterosacral ligament at the level of the uterine isthmus, without dissecting the bladder off from lower uterine segment and without separating the uterine vessels from the lateral wall of the cervix. We performed this procedure on 10 patients with pregnancy outcomes and there was no pregnancy loss. This procedure proved to be an accessible and effective surgical technique for transabdominal cerclage of the uterine cervix during early-second trimester, with affirmative prognosis.

CERVICAL ENCERCLAGE : CURRENT CONCEPTS

INTRODUCTION: The American College of Obstetricians and Gynaecology dene cervical incompetence as "the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions, labour, or both". HISTORY: Cervical cerclage was rst proposed by Dr. Vithal Shirodkar in 1955 and the 'Shirodkar technique' was rst described by him in Bombay in 1955. This technique was modied by the Australian Gynecologist and Obstetrician, I.A. McDonald. TYPES OF CERCLAGE: Depending on the route of insertion of the stitch, cerclage can be classied into – transvaginal and transabdominal (laparoscopy or laparotomy). Arobotic approach has also been introduced recently. TYPE OF SUTURE MATERIALS: Multiple suture materials have been used to perform cervical cerclage. They can be divided into – monolament and multilament (braided) sutures. Common monolament sutures used include Nylon (Ethilon) and polypropylene (Prolene) whereas braided sutures include silk and Mersilene tape. Commonly, Mersilene tape is used by physicians because of its strength, decreased possibility of tearing through tissues and ease of removal. However, braided sutures have been associated with an increased infection rate, especially when used in contaminated surgical areas CERVICAL CERCLAGE IN PLACENTA PREVIA: The rst randomized control trial for using cerclage for management of placenta previa was conducted by Arias et al,25 patients from 24-30 weeks of gestation with the result of Cerclage patients having a signicantly better perinatal outcome by more advanced gestational age at the time of delivery, larger birth weight and fewer neonatal complications also maternal bleeding was more frequent and severe for patients in the control group CERVICAL CERCLAGE IN MULTIFETALPREGNANCY: According to RCOG green top guideline no. 60, 2011, placement of history or ultrasound indicated cervical cerclage in multifetal pregnancy is not recommended as it is associated with an increased risk of pregnancy loss and preterm delivery

Ligament Augmentation With Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity

ObjectiveTo investigate prevention of proximal junctional kyphosis (PJK) and failure (PJF) following adult spinal deformity (ASD) surgery utilizing a novel technique of posterior ligament augmentation with polyester fiber tether. MethodsThis study evaluated ASD adult patients who underwent posterior decompression and instrumented fusion from the thoracolumbar junction (T9–L1) to the pelvis from 2011–2017. Basic demographic data were obtained. Radiographic outcomes included proximal junctional angle (PJA), sagittal vertical axis, PJK, and PJF. The study population was divided into patients who had ASD surgery with and without ligamentous augmentation. ResultsA total of 43 subjects were evaluated, including 20 without and 23 with ligamentous augmentation. PJA increased over time for both groups. PJA was smaller for the augmented group, and rate of increase in PJA was slower in the augmented group (p<0.0001). The rate of PJK was significantly higher in the nonaugmented group (p=0.01). PJF was significantly less common in the augmented group (p=0.003). Time to revision surgery was lower in the nonaugmented group (p=0.003). ConclusionOur novel ligament augmentation technique utilizing polyethylene tape is an effective technique to slow progression of the PJA and lower the risk for proximal junctional disease in ASD surgery.