Gulden Menderes1, Lindsay E Clark2, Masoud Azodi2. 1. Yale New Haven Health/Bridgeport Hospital, Bridgeport, Connecticut. Electronic address: guldenmenderes@yahoo.com. 2. Yale New Haven Health/Bridgeport Hospital, Bridgeport, Connecticut.
Abstract
STUDY OBJECTIVE: To show a technique of laparoscopic interval abdominal cerclage placement with the use of a needleless mersilene tape. DESIGN: Step-by-step explanation of the technique using a surgical video. SETTING: 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. INTERVENTIONS: 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. CONCLUSION: 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.
STUDY OBJECTIVE: To show a technique of laparoscopic interval abdominal cerclage placement with the use of a needleless mersilene tape. DESIGN: Step-by-step explanation of the technique using a surgical video. SETTING: 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. INTERVENTIONS: 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. CONCLUSION: 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.