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

Abstract

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.

Comparison of transvaginal cervical cerclage versus laparoscopic abdominal cervical cerclage in cervical insufficiency: a retrospective study from a single centre

“…Nevertheless, with the development of laparoscopic techniques, some new approaches for LAC may be considered as an acceptable alternative to traditional LAC due to its superiority in terms of tranvaginal removal [ 16 ]. Surgeons have had extensive experience in ensuring that the procedure is successful and minimally invasive [ 17 ]. In our study, there were no adverse events, and all patients were discharged within 24-48 h in the TAC group.…”

Pregnancy, childbirth and perinatal outcomes in isthmic-cervical insufficiency, depending on the method of delivery

“…А к основным методам лечения ИЦН в соответствии с современными клиническими рекомендациями относят комбинацию акушерского разгружаю щего пессария или серкляжа с препаратами прогестерона [12]. Следует признать, что, несмотря на большое количество проводимых в последние годы исследований, посвященных ранней диагностике и изучению эффективности использования различных способов коррекции ИЦН [13][14][15][16], проблема ведения пациенток с данной акушерской патологией не теряет своей актуальности [17,18]. Существует мнение, что своевременное выполнение операции кесарева сечения (КС) при ряде ургентных акушерских ситуаций позволяет улучшить перинатальные исходы, снижая заболеваемость и смертность новорожденных [19][20][21][22].…”