A 25-year-old woman presented with backache of 2 weeks duration and had 45-60 days menstrual cycle. On transvaginal sonography (TVS), her left adnexa showed a heterogenous solid mass of 5.3×4.2 cm and moderate vascularity on color doppler. Serum inhibin B was raised to 2249 pg/ml. MRI showed 5.5× 4.5 cm solid mass in the left ovary with lobulated margins suggestive of sex cord-stromal/ germ cell tumor. Laparoscopy showed an enlarged left ovary with intact surface. Left adnexectomy with staging biopsies and infracolic omentectomy was performed. Histopathology showed adult granulosa cell tumor with intact ovarian capsule. One-month post-surgery, inhibin B level was 44 pg/ml. She wishes to conceive after six months follow-up.

No abstract

Study Objective: Cervical insufficiency occurs in 0.1% to 1% of all pregnancies and is associated with a high risk of second-trimester abortion and/or preterm delivery [1]. Laparoscopic encerclage is highly recommended for a previous failed vaginal encerclage and is superior to the laparotomy approach in terms of low morbidity and faster recovery [2]. Laparoscopic encerclage in pregnancy is more challenging than that in the nonpregnant state. This is because of the enlarged uterine size, engorged uterine vessels, and infeasibility of using a uterine manipulator. The standardization and description of the technique are the main objectives of this video (Video 1). We have described the surgery in 6 steps that could make this procedure easier and safer. Design: A step-by-step video demonstration of the technique.