Laparoscopic Cervicoisthmic Cerclage: Technique and Systematic Review of the Literature

Abstract

Background and Aims: To report on and review the outcome after laparoscopic cervicoisthmic cerclage (LCC) and robotic-assisted laparoscopic cervicoisthmic cerclage. Methods: We reported on 4 cases of LCC and conducted a systematic review of the literature up to May 2012 to identify obstetric outcomes after LCC and robotic-assisted LCC. Results: The median age of our series was 35 years (range: 31–41) with median previous pregnancies 3.5 (2–5). All 4 women had successful obstetric outcomes with a median gestational age at delivery of 37 weeks (range: 36–38). The systematic review identified 25 studies (162 women underwent LCC and 3 had robotic-assisted LCC). In the interval LLC studies, the median age was 33 years (range: 22–42); with a median gestational age at delivery of 37 weeks (range: 34–38). For prophylactic LCC, the median age was 31 years (range: 27–41); with a gestational age at delivery of 37 weeks (range: 19–39). Two of the three robotic-assisted LCC procedures were done prophylactically. The median age was 27 years (range: 23–37) with a median gestational age at delivery of 37 weeks (range: 35–38). Conclusion: LCC is feasible during and in between pregnancies as well as in congenitally malformed uteri. Current evidence suggests that LCC might be of benefit in selected cases of cervical insufficiency with short cervices.

Laparoscopic transabdominal cervical cerclage by broad ligament window technique

“…Unfortunately, the transvaginal approach to cerclage has a failure rate of about 13%. [ 4 ] Previously failed vaginal cervical cerclage constituted the most common group for laparoscopic abdominal cerclage (100% and 94.5%), which is comparable to the systematic review by Burger et al . (>71%).…”

Uterus Preserving Reposition of Non-Puerperal Uterine Inversion under Laparoscope: A Case Report and Literature Review

“…We decided to preserve the uterus because of the young age and nulliparous history of the patient. Of course, fertility-sparing surgery and laparoscopy are tendencies [13,14]. Our case showed that preserving the uterus is possible after proper suturing of the incision and antibiotics usage.…”

Laparoscopic Cerclage in Pregnant and Nonpregnant Uterus: Emerging Need to change Conventional Management Approach

“…The results are shown in Table 1. [15][16][17][18][19][20][21][22][23][24][25] The number of patients that were treated each year ranges from 1 to 101, with majority of the cases done before pregnancy, and, in all, reveals very minimal intraoperative complications which were seen in only three cases -2009, 2013, and 2014, with intraoperative complications of 10.7, 4.5, and 1.6% respectively; others did not record any form of complications. There were no severe complications like infection, severe hemorrhage, and injury of peripheral organs.…”