Laparoscopic transabdominal cerclage in pregnancy: A single centre experience

Ades, Alex; Aref‐Adib, Mehrnoosh; Parghi, Sneha; Hong, Phoebe

doi:10.1111/ajo.12848

Cited by 16 publications

(10 citation statements)

References 18 publications

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“…In pregnant women, the mean time of surgery was 59 min. These data are comparable to those published by Gremeau et al [17] (average of 54 min) in nonpregnant women and Ades et al [18] (mean operation time of 57.5 min) in pregnant women . The rather similar operation times in pregnant and nonpregnant women in our cohort can be attributed to the fact that no additional procedures were required in pregnant women.…”

Section: Discussionsupporting

confidence: 91%

“…Neonatal survival rates were overall satisfactory and ranged from 79 to 100% [17,24]. Mean GA at delivery was between 32.9 and 37.8 weeks [15,[17][18][19]25]. The mean GA at delivery in our patients was 34 + 4 weeks.…”

Section: Discussionmentioning

confidence: 62%

“…All our postconceptional cerclage procedures were performed within the first 13 weeks of gestation (mean GA 12 + 3 weeks). Other groups also aimed at performing cerclage placement no later than the first trimester for the same reason and reported low complication rates [15, 18, 19]. The traditional surgical transabdominal technique comprises the dissection of uterine vessels to place the tape in the avascular space between the ascending and descending branches medial to the uterine arteries [13].…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Laparoscopic Transabdominal Cerclage with a “Needle-Free” Technique: A Single-Center Experience

Azim¹,

Wieser²,

Ritter³

et al. 2020

Gynecol Obstet Invest

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Background: In high-risk patients with cervical incompetence, laparoscopic cerclage is a promising treatment option. However, the procedure exhibits relevant surgical risks. Aims: The purpose of this study was to evaluate a surgical “needle-free” technique for minimally invasive, laparoscopically placed cervico-isthmic cerclage in high-risk patients. Methods: This was a retrospective observational study over a 10-year period of pre- and postconceptional cerclage placement. The included patients either experienced previous transvaginal cerclage (TVC) failure or were not eligible for TVC. Laparoscopic transabdominal cerclage using a needle-less mersilene tape was performed via a broad ligament window lateral to the uterine vessels. Results: Laparoscopic transabdominal cerclage was successfully performed in all included women with a median operation time of 62 min. We did not observe any intra- or postoperative complications, particularly no bleeding complications. Nine of 11 women became pregnant and/or carried out a successful pregnancy, respectively. Importantly, we did not observe any cases of miscarriage or mid-trimester loss. Two patients did not conceive; however, their medical histories did include Asherman’s syndrome and advanced maternal age. Conclusion: Transabdominal laparoscopic “needle-free” cerclage is a safe and effective treatment option for a well-selected group of women at high risk of cervical incompetence. It provides good obstetric results without increasing perioperative morbidity.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally Invasive Laparoscopic Transabdominal Cerclage with a “Needle-Free” Technique: A Single-Center Experience

Azim¹,

Wieser²,

Ritter³

et al. 2020

Gynecol Obstet Invest

View full text Add to dashboard Cite

show abstract

“…The laparoscopic approach is nowadays preferred by well-trained surgeons due to the advantages of shorter recovery times and hospital stays and less postoperative pain and adhesion formation than the open method. A study by Ades et al of laparoscopic transabdominal cerclage during pregnancy reported that all 19 patients enrolled in this study had no operative complications and were discharged within one day [20].…”

Section: Discussionmentioning

confidence: 61%

Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors

Chung

Lee

Song

et al. 2021

JCM

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This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.

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“…It is of vital importance for surgeons and patients to select the proper time of the cerclage placement and removal. Although the subject of whether LTCC should be performed during pregnancy remains controversial [12,15,36], there were no adverse events in all 3 pregnant participants with MLTCC-TR. To avoid the adverse effects (larger uterus, more abundant blood supply, higher risks of miscarriages) of the surgery during pregnancy [37], it was advised that our new approach be followed in nonpregnancy or first-trimester pregnancy.…”

Section: Discussionmentioning

confidence: 89%

A Novel Cerclage Insertion: Modified Laparoscopic Transabdominal Cervical Cerclage with Transvaginal Removing (MLTCC-TR)

Wang

Duan

Zhang

et al. 2020

Journal of Minimally Invasive Gynecology

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To report on our center's experience of a novel modified approach for laparoscopic cervical cerclage and to evaluate its safety and efficacy preliminarily. Design: Retrospective descriptive study. Setting: Single academic institution. Patients: Pregnant and nonpregnant women who underwent the modified laparoscopic transabdominal cervical cerclage with transvaginal removing (MLTCC-TR) from June 2016 to April 2019. Eligible participants had multiple adverse obstetric histories or the short cervix and were not suitable for a second transvaginal cerclage. Interventions: Preconceptional or postconceptional MLTCC-TR. Measurements and Main Results: A total of 24 participants (including 3 first-trimester singleton pregnant women) underwent the MLTCC-TR, giving birth to 27 infants. Among 21 women who underwent preconceptional cerclage, 26 cases of postoperational pregnancies were noted, and the incidence of term labor was 73.07%, which was significantly higher than that in the precerclage group (p <.001). Their mean gestational age at delivery was 37.21 § 5.05 weeks. Among 3 cases of postconceptional cerclage, the mean gestational age at cerclage was 10.90 § 2.61 weeks, and all of them had term delivery. The overall neonatal survival rate was 100% (27/27), of which 81.48% (22/27) were term infants. There were no severe perioperative complications directly related to the insertion of cerclage. Conclusion:Our new approach of MLTCC-TR may be a relatively effective, feasible, and safe treatment for cervical insufficiency. It may be considered as an acceptable alternative to the traditional laparoscopic cervical cerclage with its superiority of transvaginal removing.

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Laparoscopic transabdominal cerclage in pregnancy: A single centre experience

Abstract: Laparoscopic transabdominal cerclage is a safe and effective procedure in women with poor obstetric histories. It requires the correct skill, expertise and patient selection.

Cited by 16 publications

References 18 publications

Minimally Invasive Laparoscopic Transabdominal Cerclage with a “Needle-Free” Technique: A Single-Center Experience

Minimally Invasive Laparoscopic Transabdominal Cerclage with a “Needle-Free” Technique: A Single-Center Experience

Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors

A Novel Cerclage Insertion: Modified Laparoscopic Transabdominal Cervical Cerclage with Transvaginal Removing (MLTCC-TR)

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