Robotic-Assisted Laparoscopic Placement of Transabdominal Cerclage During Pregnancy

ABSTRACT

Cervical incompetence treated with transabdominal cerclage can carry significant morbidity with the need for sequential laparotomies and necessitating prolonged postoperative recovery. Laparoscopic transabdominal cerclage placement has been described but has significant limitations with only two-dimensional depth perception and limited dexterity. Robotic-assisted laparoscopic surgery (RALS) is rapidly gaining acceptance in gynecologic surgery. RALS has reportedly been used for placement of an interval transabdominal cerclage. We report the first two cases where the da Vinci^® robot was used during pregnancy for placement of abdominal cerclage. Two women were successfully treated with robotic-assisted laparoscopic placement of transabdominal cerclage in pregnancy. Robotic-assisted laparoscopic transabdominal cerclage placement is less invasive and is effective not only as an interval procedure but also during pregnancy, offering the patient an alternative to the traditional laparotomy with quicker recovery time.

Abdominal cerclage - cervical incompetence - da Vinci robot^®

REFERENCES

• 1 Al-Fadhli R, Tulandi T. Laparoscopic abdominal cerclage.  Obstet Gynecol Clin North Am. 2004;  31 497-504
• 2 McDonald I A. Suture of the cervix for inevitable miscarriage.  J Obstet Gynecol Br Emp. 1957;  64 346-350
• 3 Benson R C, Durfee R B. Transabdominal cervicouterine cerclage during pregnancy for the treatment of cervical incompetency.  Obstet Gynecol. 1965;  25 145-155
• 4 Novy M J. Transabdominal cervicoisthmic cerclage: a reappraisal 25 years after its introduction.  Am J Obstet Gynecol. 1991;  164 1635-1641
• 5 Aboujaoude R, Maloof P, Alvarez M, Khan A. A novel method for laparoscopic abdominal cerclage utilizing minimally invasive hydrodissection.  J Reprod Med. 2007;  52 428-430
• 6 Lesser K B, Childers J M, Surwit E A. Transabdominal cerclage: a laparoscopic approach.  Obstet Gynecol. 1998;  91 855-856
• 7 Barmat L, Glaser G, Davis G, Craparo F. Da Vinci-assisted abdominal cerclage.  Fertil Steril. 2007;  88 1437.e1-1437.e3