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Laparoscopic Abdominal Cerclage

  • Minimally Invasive Gynecologic Surgery (S Puntambekar, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This article reviews the current state of the literature as regards to the indications, outcomes, and techniques of laparoscopic abdominal cerclage.

Recent Findings

Laparoscopic abdominal cerclage is a safe and effective method for the treatment of refractory cervical insufficiency or anatomic restriction to transvaginal cerclage placement. Laparoscopic cerclage has similar success rates to open abdominal cerclage and is the preferred approach given reduced blood loss, postoperative pain, length of stay, and cost. Laparoscopic placement prior to conception may improve feasibility of the procedure and decrease complications. Various surgical techniques to aid in suture placement have been described.

Summary

Laparoscopic cerclage is a highly successful intervention for the treatment of cervical insufficiency. Continued research is needed to further define the surgical and obstetric benefits of this method.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ludmir J. Sonographic detection of cervical incompetence. Clin Obstet Gynecol. 1988;31:101–9.

    Article  CAS  PubMed  Google Scholar 

  2. Rust O, Odibo A. American College of Obstetricians and Gynecologists. Practice Bulletin: Cerclage for the Management of Cervical Insufficiency. Number 142. 2014.

  3. Lee SE, Romero R, Park CW, Jun JK, Yoon BH. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol. 2008;198:633.e1–8.

    Article  Google Scholar 

  4. Wei SQ, Fraser W, Luo ZC. Inflammatory cytokines and spontaneous preterm birth in asymptomatic women: a systematic review. Obstet Gynecol. 2010;116:393–401.

    Article  PubMed  Google Scholar 

  5. Lash AF, Lash SR. Habitual abortion: the incompetent internal os of the cervix. Am J Obstet Gynecol. 1950;59:68–76.

    Article  CAS  PubMed  Google Scholar 

  6. Shirodkar VN. A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic. 1955;52:299–300.

    Google Scholar 

  7. McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp. 1957;64:346–50.

    Article  CAS  PubMed  Google Scholar 

  8. Harger JH. Comparison of success and morbidity in cervical cerclage procedures. Obstet Gynecol. 1980;56:543–8.

    CAS  PubMed  Google Scholar 

  9. Berghella V, Szychowski JM, Owen J, Hankins G, Iams JD, Sheffield JS, et al. Suture type and ultrasound-indicated cerclage efficacy. J Matern Fetal Neonatal Med. 2012;25:2287–90.

    Article  PubMed  Google Scholar 

  10. Benson RC, Durfee RB. Transabdominal cervicouterine cerclage during pregnancy for the treatment of cervical incompetency. Obstet Gynecol. 1965;25:145–55.

  11. Novy MJ. Transabdominal cervicoisthmic cerclage: a reappraisal 25 years after its introduction. Am J Obstet Gynecol. 1991;164:1635–41.

    Article  CAS  PubMed  Google Scholar 

  12. Lesser KB, Childers JM, Surwit EA. Transabdominal cerclage: a laparoscopic approach. Obstet Gynecol. 1998;91:855–6.

    CAS  PubMed  Google Scholar 

  13. Debbs RH, DeLa Vega GA, Pearson S, Sehdev H, Marchiano D, Ludmir J. Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage. Am J Obstet Gynecol. 2007;197:317.e1–4.

    Article  Google Scholar 

  14. Cammarano CL, Herron MA, Parer JT. Validity of indications for transabdominal cervicoisthmic cerclage for cervical incompetence. Am J Obstet Gynecol. 1995;172:1871–5.

    Article  CAS  PubMed  Google Scholar 

  15. Mahran M. Transabdominal cervical cerclage during pregnancy. A modified technique. Obstet Gynecol. 1978;52:502–6.

    CAS  PubMed  Google Scholar 

  16. Sumners JE, Kuper SG, Foster TL. Transabdominal cerclage. Clin Obstet Gynecol. 2016;59:295–301.

    Article  PubMed  Google Scholar 

  17. Fick AL, Caughey AB, Parer JT. Transabdominal cerclage: can we predict who fails. J Matern Fetal Neonatal Med. 2007;20:63–7.

    Article  PubMed  Google Scholar 

  18. Witt MU, Joy SD, Clark J, Herring A, Bowes WA, Thorp JM. Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol. 2009;201:105.

  19. Foster TL, Moore ES, Sumners JE. Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon. J Obstet Gynaecol. 2011;31:713–7.

    Article  CAS  PubMed  Google Scholar 

  20. Zaveri V, Aghajafari F, Amankwah K, Hannah M. Abdominal versus vaginal cerclage after a failed transvaginal cerclage: a systematic review. Am J Obstet Gynecol. 2002;187:868–72.

    Article  PubMed  Google Scholar 

  21. Davis G, Berghella V, Talucci M, Wapner RJ. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol. 2000;183:836–9.

    Article  CAS  PubMed  Google Scholar 

  22. Ades A, Dobromilsky K. Transabdominal cervical cerclage: laparoscopy versus laparotomy. J Minim Invasive Gynecol. 2015;22:968–73.

    Article  PubMed  Google Scholar 

  23. Auber M, Hamou L, Roman H, Resch B, Verspyck E, Marpeau L. Transabdominal cervico-isthmic cerclage: 13 cases at Rouen University Hospital. Gynecol Obstet Fertil. 2012;40:741–5.

    Article  CAS  PubMed  Google Scholar 

  24. Burger NB, Brölmann HA, Einarsson JI, Langebrekke A, Huirne JA. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy; systematic review. J Minim Invasive Gynecol. 2011;18:696–704. The authors performed the largest systematic literature review to-date including 31 studies on laparoscopic and abdominal cerclage. They concluded that abdominal cerclage by either approach is associated with high fetal survival rates and minimal complications.

    Article  CAS  PubMed  Google Scholar 

  25. Carter JF, Soper DE, Goetzl LM, Van Dorsten JP. Abdominal cerclage for the treatment of recurrent cervical insufficiency: laparoscopy or laparotomy? Am J Obstet Gynecol. 2009;201:111.e1–4.

    Article  Google Scholar 

  26. Huang X, Ma N, Li TC, Guo Y, Song D, Zhao Y, et al. Simplified laparoscopic cervical cerclage after failire of vaginal suture: technique and results of a consecutive series of 100 cases. Eur J Obstet Gynecol Reprod Bio. 2016;201:146–50.

    Article  Google Scholar 

  27. Whittle WL, Singh SS, Allen L, Glaude L, Thomas J, Windrim R, et al. Laparoscopic cervico-isthmic cerclage: surgical technique and obstetric outcomes. Am J Obstet Gynecol. 2009;201:364.e1–7.

    Article  Google Scholar 

  28. Tulandi T, Alghanaim N, Hakeem G, Tan X. Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy. J Minim Invasive Gynecol. 2014;21:987–93. This review of 16 studies of abdominal cerclage showed high success rates regardless of the timing or surgical approach. The authors advocated for laparoscopic placement prior to conception given the inherent benefits of laparoscopy and ease of preconceptional placement.

    Article  PubMed  Google Scholar 

  29. Barmat L, Glaser G, Davis G, Craparo F. Da Vinci-assisted abdominal cerclage. Fertil Steril. 2007;88:1437.e1–3.

    Article  Google Scholar 

  30. Fechner AJ, Alvarez M, Smith DH, Al-Khan A. Robotic-assisted laparoscopic cerclage in a pregnant patient. Am J Obstet Gynecol. 2009;200:e10–1.

    Article  PubMed  Google Scholar 

  31. Foster TL, Addleman RN, Moore ES, Sumners JE. Robotic-assisted prophylactic transbadominal cervical cerclage in singleton pregnancies. J Obstet Gynaecol. 2013;33:821–2.

    Article  CAS  PubMed  Google Scholar 

  32. Menderes G, Clark LE, Azodi M. Needleless laparoscopic abdominal cerclage placement. J Minim Invasive Gynecol. 2015;22:321.

    Article  PubMed  Google Scholar 

  33. Menderes G, Clark M, Clark-Donat L, Azodi M. Robotic-assisted abdominal cerclage placement during pregnancy and its challenges. J Minim Invasive Gynecol. 2015;22:713–4.

    Article  PubMed  Google Scholar 

  34. Moore ES, Foster TL, McHugh K, Addleman RN, Sumners JE. Robotic-assisted transabdominal cerclage (RoboTAC) in the non-pregnant patient. J Obstet Gynaecol. 2012;32:643–7.

    Article  CAS  PubMed  Google Scholar 

  35. Wolfe L, DePasquale S, Adair CD, Torres C, Stallings S, Briery C, et al. Robotic-assisted laparoscopic placement of transabdominal cerclage during pregnancy. Am J Perinatol. 2008;25:653–5.

    Article  PubMed  Google Scholar 

  36. Zeybek B, Borahay M, Kilic GS. Overcoming the obstacles of visualization in robotically-assisted abdominal cerclage using indocyanine green. J Minim Invasive Gynecol. 2015;22:S153.

  37. Mourad J, Burke YZ. Needleless robotic-assisted abdominal cerclage in pregnancy and nonpregnant patients. J Minim Invasive Gynecol. 2016;23:298–9.

    Article  PubMed  Google Scholar 

  38. Dawood F, Farquharson RG. Transabdominal cerclage: preconceptual versus first trimester insertion. Eur J Obstet Gynecol Reprod Bio. 2016;199:27–31. This was a recent cohort study of 161 patients comparing preconceptual versus first trimester open abdominal cerclage. The authors concluded that preconceptional open abdominal cerclage is more effective in preventing mid-trimester loss and preterm labor, and is associated with lower surgical and obstetric morbidity that first trimester open abdominal cerclage.

    Article  Google Scholar 

  39. Chen Y, Liu H, Gu J, Yao S. Therapeutic effect and safety of laparoscopic cervical cerclage for treatment of cervical insufficiency in first trimester or non-pregnant phase. Int J Clin Exp Med. 2015;8:7710–8.

    PubMed  PubMed Central  Google Scholar 

  40. Pearl J, Price R, Richardson W, Fanelli R, Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011;25:3479–92.

    Article  PubMed  Google Scholar 

  41. Al-Fadhli R, Tulandi T. Laparoscopic abdominal cerclage. Obstet Gynecol Clin N Am. 2004;31:497–504.

    Article  Google Scholar 

  42. Groom KM, Jones BA, Edmonds DK, Bennett PR. Preconception transabdominal cervicoisthmic cerclage. Am J Obstet Gynecol. 2004;191:230–4.

    Article  PubMed  Google Scholar 

  43. Rust OA, Atlas RO, Jones KJ, Benham BN, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os. Am J Obstet Gynecol. 2000;183:830–5.

    Article  CAS  PubMed  Google Scholar 

  44. Shin S, Chung H, Kwon SH, Cha SD, Lee HJ, Kim AR, et al. The feasibility of a modified method of laparoscopic transabdominal cervicoisthmic cerclage during pregnancy. J Laparoendosc Adv Surg Tech A. 2015;25:651–6.

    Article  PubMed  Google Scholar 

  45. Plante M. Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer. 2013;23:982–9.

    Article  PubMed  Google Scholar 

  46. Agdi M, Tulandi T. Placement and removal of abdominal cerclage by laparoscopy. Reprod Biomed Online. 2008;16:308–10.

    Article  PubMed  Google Scholar 

  47. Carter JF, Soper DE. Laparoscopic removal of abdominal cerclage. JSLS. 2007;11:375–7.

    PubMed  PubMed Central  Google Scholar 

  48. Scarantino SE, Reilly JG, Moretti ML, Pillari VT. Laparoscopic removal of a transabdominal cervical cerclage. Am J Obstet Gynecol. 2000;182:1086–8.

    Article  CAS  PubMed  Google Scholar 

  49. Carter JF, Savage A, Soper DE. Laparoscopic removal of abdominal cerclage at 19 weeks’ gestation. JSLS. 2013;17:161–3.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Martin A, Lathrop E. Controversies in family planning: management of second-trimester losses in the setting of an abdominal cerclage. Contraception. 2013;87:728–31.

    Article  PubMed  Google Scholar 

  51. Chandiramani M, Chappell L, Radford S, Shennan A. Successful pregnancy following mid-trimester evacuation through a transabdominal cerclage. BMJ Case Rep 2011.

  52. Burger NB, Einarsson JI, Brölmann HA, Florentien EM, Vree MD, McElrath TF, et al. Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study. Am J Obstet Gynecol. 2012;207:273.e1–12.

    Article  Google Scholar 

  53. Hawkins E, Nimaroff M. Vaginal erosion of an abdominal cerclage 7 years after laparoscopic placement. Obstet Gynecol. 2014;123:420–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis St, ASB1-3, Boston, MA, 02115, USA

    Nisse V. Clark & Jon I. Einarsson

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  1. Nisse V. Clark
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  2. Jon I. Einarsson
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Correspondence to Nisse V. Clark.

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Conflict of Interest

Nisse V. Clark and Jon I. Einarsson declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

This article is part of the Topical Collection on Minimally Invasive Gynecologic Surgery

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Clark, N.V., Einarsson, J.I. Laparoscopic Abdominal Cerclage. Curr Obstet Gynecol Rep 5, 348–354 (2016). https://doi.org/10.1007/s13669-016-0179-6

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  • DOI: https://doi.org/10.1007/s13669-016-0179-6

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