Laparoscopic Cervical Cerclage Surgery
Cervical shortening in reproductive age group female is believed to be a marker for generalized intrauterine recurrent inflammation and has a strong association in pregnant women with spontaneous preterm birth. For these patients who has recurrent abortion a variety of therapies, including vaginal and intramuscular progesterone, pessary, and cervical cerclage, have been demonstrated to be effective in specific clinical circumstances.
For these female patients cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy or during thirteen week of pregnancy. A laparoscopic approach may be superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity.
Recent advancement in the field of laparoscopic and robotic surgery resulted in development of a new approach to cervical cerclage placement. Laparoscopic cervical cerclage offers the benefit of reduced blood loss, reduced postoperative pain, and fewer adhesions, as well as decreased length of hospital stay and overall faster recovery time.
Similar to the transabdominal approach, laparoscopic cerclage can be placed during pregnancy or as an interval procedure. Success rates for laparoscopic cerclage were reported in the range of 76% to 100%), which is comparable with fetal survival rates following transabdominal cerclage. Complications of laparoscopic cerclage are similar to those associated with transabdominal cerclage and include uterine vessel bleeding, impaired surgical visibility due to morbid obesity, perioperative pregnancy loss, infection, and thromboembolism.
A laparoscopic approach to cervical cerclage placement is a potentially effective adjunct to the treatment of women at high risk of recurrent preterm birth. Laparoscopic or da Vinci robotic approaches yield similar obstetric outcomes, and laparoscopic cerclage may be a superior method in terms of surgical outcomes, as suggested by several studies. A prospective, randomized trial is needed in order to clearly establish the specific benefits to both surgical and obstetrical outcomes.
|Older Post||Home||Newer Post|