Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes

Abstract

To compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches. Design: Retrospective cohort study. Setting: An academic medical center. Patients: Sixty-nine women with acquired or congenital cervical insufficiency. Interventions: All women underwent TAC either by laparotomy or robotic-assisted approaches by 2 primary surgeons between January 2003 and July 2018. Women with a preconceptional TAC without a subsequent pregnancy were excluded. Measurements and Main Results: A total of 69 women met inclusion criteria in the 15-year study period with 40 in the historical TAC-LAP group and 29 in the TAC-RA group. Gestational age at delivery was similar in the 2 groups (36 weeks 3 days vs 37 weeks; median difference À1 day, 95% confidence interval [CI] À6 to 2, p = .36). There were no differences in birth weight, Apgar scores, neonatal intensive care unit admission, or neonatal survival. Estimated blood loss and length of stay were significantly greater in the TAC-LAP group (50 mL vs 20 mL; median difference 25, 95% CI 5−40, p = .007 and 76 hours vs 3 hours; median difference 71, 95% CI 65−75, p <.001, respectively). Operative time was significantly shorter in the TAC-LAP group (65 minutes vs 132 minutes; median difference À64.7, 95% CI À79 to À49, p <.001). There was one intra-operative complication and 4 minor postoperative complications in the TAC-LAP group and none observed in the TAC-RA group. All outcomes were similar when comparing postconceptional TAC alone, except there was no longer a difference in blood loss. When comparing pre-versus postconceptional robotic TAC, there were no differences in surgical outcomes. Conclusion: Robotic TAC has similar favorable obstetric outcomes to traditional laparotomy and is associated with reduced blood loss and shorter hospital stays. Despite longer operative times, the robotic group did not experience any intra-operative or postoperative complications, which speaks to the benefits of this minimally invasive approach to TAC.

The minimally invasive approach to abdominal cerclage: indications, complications, and techniques for placement

“…An open approach to TAC placement via laparotomy (TAC-lap) was first described in the 1960 s and a laparoscopic approach (TAC-lsc) was first used in the late 1990 s. Laparoscopy is generally preferred to laparotomy given improved visualization and lower rates of hemorrhage, wound complications, postoperative pain, length of hospital stay, and subsequent adhesive disease. Multiple studies have confirmed that TAC-lsc is associated with a statistically significant decrease in blood loss, wound infections, and length of hospital stay when compared to TAC-lap [17 ▪▪ ,21,22].…”

Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency

“…The laparoscopic approach is favored for many procedures given reduced blood loss, fewer wound complications, a shorter length of stay, and a faster return to normal activities compared with an open approach (28-30). These advantages likely apply to laparoscopic abdominal cerclage, and one study confirmed reduced blood loss and reduced length of stay with a robotic-assisted laparoscopic abdominal cerclage compared with an open abdominal cerclage (31). Laparoscopy lends improved visualization of the pelvic anatomy, aiding in avoidance of uterine vessel injury, a feared complication of abdominal cerclage.…”