Transabdominal Cerclage Placement Research Articles

Robotic-Assisted Laparoscopic Placement of Transabdominal Cerclage During Pregnancy

Cervical incompetence treated with transabdominal cerclage can carry significant morbidity with the need for sequential laparotomies and necessitating prolonged postoperative recovery. Laparoscopic transabdominal cerclage placement has been described but has significant limitations with only two-dimensional depth perception and limited dexterity. Robotic-assisted laparoscopic surgery (RALS) is rapidly gaining acceptance in gynecologic surgery. RALS has reportedly been used for placement of an interval transabdominal cerclage. We report the first two cases where the da Vinci robot was used during pregnancy for placement of abdominal cerclage. Two women were successfully treated with robotic-assisted laparoscopic placement of transabdominal cerclage in pregnancy. Robotic-assisted laparoscopic transabdominal cerclage placement is less invasive and is effective not only as an interval procedure but also during pregnancy, offering the patient an alternative to the traditional laparotomy with quicker recovery time.

Laparoscopic transabdominal cervico‐isthmic cerclage: A minimally invasive approach

While the traditional approach to management of cervical insufficiency has been the insertion of a transvaginal cerclage during pregnancy, a transabdominal cervico-isthmic suture is indicated in certain patients. This procedure is traditionally performed via laparotomy. Laparoscopic transabdominal cervico-isthmic cerclage (LTCC) placement, however, confers the benefit of the low morbidity associated with laparoscopy. To describe the technique and outcomes of LTCC in three cases. LTCC was performed using Mersilene tape at the level of the internal cervical os in the prepregnancy period in three patients: one with previous cervical amputation and two with previous failed cervical cerclage. Procedures were performed at a tertiary level endoscopic unit, Sydney, Australia. The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in these cases. Laparoscopic cervical cerclage proved technically feasible and safe for a surgeon trained in laparoscopic suturing methods.

Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage

The purpose of this study was to assess the outcome after transabdominal-cerclage placement during pregnancy in women with previous unsuccessful transvaginal cerclage. We conducted a retrospective case series that described pregnancy outcome in women who were treated with transabdominal cerclage between 1994 and 2006. Seventy-five women with negative evaluation for recurrent pregnancy loss and > or = 1 previous unsuccessful transvaginal cerclage procedures were treated with transabdominal cerclage. The median gestational age at the time of cerclage placement was 13 weeks, and the median gestational age at delivery was 36 weeks. Seventy-two women delivered after 24 weeks of gestation, and 3 women delivered < or = 24 weeks of gestation. The fetal-salvage after transabdominal cerclage was 96%. Our findings suggest that, in women with a history of > or = 1 failed transvaginal cerclage, transabdominal cerclage is an effective procedure.

Transabdominal cerclage: Can we predict who fails?

Objective. To examine the outcome of pregnancies in women with transabdominal cerclage (TAC) and to determine whether aspects of the obstetric history predict failure.Methods. This was a cohort study of pregnant women referred for a transabdominal cerclage between 1978 and 2004. Records were reviewed for obstetric history and maternal demographics. Predictor variables were prior pregnancy loss, prior vaginal cerclage, associated factors for TAC, and maternal age. The outcome variable was delivery of an infant beyond 24 weeks who survived the neonatal period. Outcomes were compared using Student's t-test, standard z-test, and Chi-square test.Results. Eighty-eight women delivered 96 pregnancies after TAC placement. The fetal salvage rate prior to TAC was 18%, 93% after the procedure (p < 0.001). Delivery beyond 37 weeks occurred in 70% of pregnancies. Maternal age, prior cerclage history, associated factors for TAC, or previous delivery of a viable infant did not predict the eight failures out of the 96 pregnancies.Conclusion. Women with TAC had a higher rate of successful pregnancies than prior to TAC. Neither maternal age nor prior pregnancy loss predicted failure. However with such a high success rate, we would have needed 948 women to do so. TAC is an option for women with a poor obstetric history including failed vaginal cerclage.

Clinical outcomes following interval laparoscopic transabdominal cervico-isthmic cerclage placement: case series.

The purpose of this report is to describe outcomes following laparoscopic transabdominal cervico-isthmic cerclage placement in cases of cervical incompetence not amenable to a conventional transvaginal procedure. We reviewed records of the first 11 patients at an academic teaching hospital who underwent laparoscopic transabdominal cerclage placement as an interval procedure, using a technique we previously first described. For all patients, the clinical course, including surgical complications and outcome of all subsequent pregnancies, is briefly described. One case was complicated by a small bowel injury secondary to concomitant extensive enterolysis. Otherwise there were no complications. Mean estimated blood loss was <40 ml. To date, 10 patients have conceived a total of 12 pregnancies following the procedure. Two pregnancies resulted in spontaneous losses at 8 weeks gestation, two in deliveries by Caesarean section at 34.5 weeks, and eight in deliveries by elective Caesarean section at 38 weeks or more. Each delivery resulted in the birth of a healthy infant. In conclusion, patients who require a transabdominal cerclage may undergo a laparoscopic interval procedure and achieve outcomes similar to those following placement via laparotomy during pregnancy.

Laparoscopic transabdominal cervicoisthmic cerclage

Objective: To report a laparoscopic technique for placement of a transabdominal cervicoisthmic cerclage. Design: Detailed case report of one of three patients undergoing described procedure. Setting: University hospital. Patient: A 39-year-old infertile patient with a history of cervical adenocarcinoma in situ and two cone biopsies, resulting in an essentially absent exocervix. Intervention(s): Laparoscopic transabdominal cervicoisthmic cerclage placement, as an interval procedure, followed by ET of cryopreserved donor oocyte-derived embryos. Main Outcome Measure(s): Clinical outcome. Result(s): Establishment of a pregnancy delivered at 38 1 2 weeks of gestation by elective cesarean section. Conclusion(s): Patients believed to require a transabdominal cerclage may undergo a laparoscopic interval procedure, obviating the need for a laparotomy before or during pregnancy.