Laparoscopic abdominal cerclage

Abstract

Objective of the study: To demonstrate the laparoscopic abdominal cerclage technique and thus offer this minimally invasive procedure to patients. Design: To perform the surgery step by step through a video with narration. Introduction: Preterm delivery is a major cause of neonatal morbidity and mortality. Cervical isthmic incompetence is one of the causes of preterm delivery and it is estimated that up to 1% of all pregnancies may be complicated by this reason. Abdominal cerclage is indicated in patients with extremely short cervix, cervical deformity, absence of cervix and history of previous vaginal cerclage failure. Performing abdominal cerclage via laparoscopy offers many advantages: less adhesions, less postoperative pain, no hospitalization required, few complications and rapid recovery of the patient. Procedure: In this case we performed a prophylactic abdominal cerclage via laparoscopy (non-pregnant patient) in a 36-year-old woman with a history of vaginal cerclage in her previous pregnancy with failure of this and pregnancy loss. We started the surgery with access to the abdominal cavity at the umbilical level with open technique (Hasson) and placement of three 5 mm accessory trocars, suprapubic and in both iliac fossae (French triangulation). We then released multiple adhesions of omentum and small bowel to the anterior abdominal wall. We performed the cerclage in 6 steps: Vesico-uterine plica dissection 2. Pass the distal end of the mersilene needle through the hole in the right broad ligament and then pass the needle inside the uterine vessels 4. Introduce the needle inside the left uterine vessels and without the need to perforate the broad ligament on this side. Closure of the peritoneum of the vesico-uterine plica with synthetic absorbable monofilament Conclusion: Laparoscopic abdominal cerclage is a safe technique and offers the advantages of minimal invasion to patients. It has demonstrated through multiple publications its success rate in preventing pregnancy loss due to cervical isthmic incompetence.