Page 40 - World Journal of Laparoscopic Surgery

Oluwole E Ayegbusi
with minimal complications. There is an increasing 2. ACOG Practice Bulletin No.142: Cerclage for the management
need to start giving consideration to transabdominal of cervical insufficiency. Obstet Gynecol 2014 Feb;123(2 Pt 1):
laparoscopic cerclage. 372-379.
The laparoscopic approach has further advantages 3. Shin JE, Kim MJ, Kim GW, Lee DW, Lee MK, Kim SJ. Lapa-
of obviating the need for a laparotomy, reducing the roscopic transabdominal cervical cerclage: case report of
a woman without exocervix at 11 weeks gestation. Obstet
abdominal wall trauma and the recovery time, with Gynecol Sci 2014 May;57(3):232-235.
short hospital stay, avoiding repeated laparotomy, and 4. Chen Y, Liu H, Gu J, Yao S. Therapeutic effect and safety of
indirectly reducing de novo postoperative adhesion laparoscopic cervical cerclage for treatment of cervical insuf-
formation; this aspect cannot be overemphasized, which ficiency in first trimester or non-pregnant phase. Int J Clin
most obstetricians detest. Exp Med 2015 May;8(5):7710-7718.
Finally, laparoscopic procedures, especially gasless 5. Marilien G, Yves J, Jérôme C. Laparoscopic transabdominal
cerclage. Surg Sci 2013 Apr;4(4):231-235.
1
ones, appear to be safe for both the mother and fetus. 6. Shirodkar VN. A new method of operative treatment for
The procedure also avoids the risk of ascending lower habitual abortion in the second trimester of pregnancy.
genital tract infections, which are occasionally seen in Antiseptic 1955;52(2):299-300.
transvaginal cerclage and could result in abortions or 7. McDonald IA. Suture of the Cervix for inevitable miscarriage.
preterm delivery as the case may be. J Obstet Gynaecol Br Emp 1957 Jun;64(3):346-350.
8. Benson RC, Durfee RB. Transabdominal cervicouterine
CONCLUSION cerclage during pregnancy for the treatment of cervical
incompetency. Obstet Gynecol 1965 Feb;25(2):145-155.
In patients that are indicated, laparoscopic approach 9. Scibetta JJ, Sanko SR, Phipps WR. Laparoscopic transab-
to cervical cerclage placement is an effective and safe dominal cervicoisthmic cerclage. Fertil Steril 1998 Jan;69(1):
adjunct to the treatment of cervical insufficiency, as 161-163.
evident by the obstetric outcomes. Also, laparoscopic cer- 10. Lesser KB, Childers JM, Surwit EA. Transabdominal cerclage:
a laparoscopic approach. Obstet Gynecol 1998 May;91(5 pt 2):
clage may also be a superior method in terms of surgical 855-856.
outcomes, as suggested by several studies. 11. Luo L, Chen SQ, Jiang HY, Niu G, Wang Q, Yao SZ. Success-
However, there is still need for more studies and, ful treatment of cervical incompetence using a modified
especially, considering fetal outcomes of laparoscopic laparoscopic cervical cerclage technique: a cohort study. Eur
J Obstet Gynecol Reprod Biol 2014 Aug;179:125-129.
cerclage and laparotomy cerclage with transvaginal cer- 12. Riiskjaer M, Petersen OB, Uldbjerg N, Hvidman L, Helmig RB,
clage, there is a need to do more in terms of increasing Forman A. Feasibility and clinical effects of laparoscopic
expertise in order to reduce complications to the barest abdominal cerclage: an observational study. Acta Obstet
minimum. It may be advisable to consider laparoscopic Gynecol Scand 2012 Nov;91(11):1314-1318.
transabdominal cerclage before pregnancy, i.e., as an 13. Nicolet G, Cohen M, Begue L, Reyftmann L, Boulot P,
interval procedure. Déchaud H. Laparoscopic cervico-isthmic cerclage evalua-
Apart from those stated above, the following ques- tion. Gynecol Obstet Fertil 2009 Apr;37(4):294-299.
tions may, therefore, need answers in future studies: 14. Harger JH. Cerclage and cervical insufficiency: an evidence-
based analysis. Obstet Gynecol 2002 Dec;100(6):1313-1327.
• Should cerclage placed via laparoscopy be done before 15. Liddell HS, Lo C. Laparoscopic cervical cerclage: a series
or after pregnancy? in women with a history of second trimester miscarriage.
• Will there be an effect on fertilization if laparoscopic J Minim Invasive Gynecol 2008;15:342-345.
cerclage is done before pregnancy? 16. Whittle WL, Singh SS, Allen L, Glaude L, Thomas J,
Windrim R, Leyland N. Laparoscopic cervico-isthmic cer-
clage: surgical technique and obstetric outcomes. Am J Obstet
ACKNOWLEDGMENT Gynecol 2009;201:364.e361-364.e367.
17. Fechner AJ, Alvarez M, Smith DH, Al-Khan A. Robotic-
The author appreciates the authors of all the papers assisted laparoscopic cerclage in a pregnant patient. Am J
reviewed as acknowledged in the references. The author Obstet Gynecol 2009;200:e10-e11.
is particularly grateful to the entire staff of World Lapa- 18. Carter JF, Soper DE, Goetzl LM, Van Dorsten JP. Abdomi-
roscopy Hospital, Gurgaon, India, under the leadership nal cerclage for the treatment of recurrent cervical insuf-
of a wonderful teacher, Professor RK Mishra. ficiency: laparoscopy or laparotomy? Am J Obstet Gynecol
2009;201:111.e111-111.e114.
19. Pereira L, Cotter A, Gómez R, et al. Expectant management
REFERENCES compared with physical examination indicated cerclage
(EM-PEC) in selected women with a dilated cervix at 14(0/7)-
1. Gallot D, Savary D, Laurichesse H, Bournazeau JA, Amblard J, 25(6/7) weeks: results from the EM-PEC international cohort
Lémery D. Experience with three cases of laparoscopic study. Am J Obstet Gynecol 2007;197:483.e1-483.e8.
transabdominal cervico-isthmic cerclage and two subsequent 20. Palacio M, Cobo T, Bosch J, et al. Cervical length and gestational
pregnancies. BJOG 2003 Jul;110(7):696-700. age at admission as predictors of intra amniotic inflammation

38