This video demonstrate laparoscopic cervical cerclage performed by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic Cervical cerclage, also known as a cervical stitch, is a treatment for cervical incompetence or insufficiency, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth in second trimester. As a general rule, laparoscopic cervical cerclages work best when they are placed early in pregnancy and when the cervix is longer and thicker. Rates for carrying the pregnancy to term after cerclage vary from 85 to 90 percent, depending on the type of cerclage used.
Cervical incompetence, also known as cervical insufficiency, is a condition in which the cervix shortens or opens prematurely during pregnancy, often leading to recurrent mid-trimester pregnancy losses or preterm births. Cervical cerclage is a well-established surgical procedure designed to reinforce the cervix and improve pregnancy outcomes. With advancements in minimally invasive surgery, laparoscopic cervical cerclage has emerged as a safe, effective, and superior alternative to traditional open or vaginal approaches in selected patients.

What Is Laparoscopic Cervical Cerclage?

Laparoscopic cervical cerclage is a minimally invasive surgical technique in which a non-absorbable suture or tape is placed around the cervix at the level of the internal os using laparoscopic instruments. The procedure provides strong mechanical support to the cervix throughout pregnancy and is particularly beneficial for women in whom vaginal cerclage has failed or is anatomically not feasible.

Indications for Laparoscopic Cervical Cerclage

Laparoscopic cerclage is recommended in the following situations:

Recurrent second-trimester pregnancy losses due to cervical incompetence

Failure of previous vaginal cervical cerclage

Congenital or acquired short cervix

Cervical trauma following surgical procedures such as conization or trachelectomy

Anatomical distortion of the cervix making vaginal cerclage difficult

Timing of the Procedure

Laparoscopic cervical cerclage can be performed:

Pre-pregnancy (interval cerclage): Ideal timing with minimal risk to pregnancy

Early pregnancy (11–14 weeks gestation): When cervical incompetence is diagnosed early

Pre-pregnancy cerclage is often preferred as it allows optimal visualization and avoids uterine manipulation during pregnancy.

Surgical Technique

The procedure is performed under general anesthesia and involves the following steps:

Creation of laparoscopic ports

Identification of uterine vessels and cervico-isthmic junction

Careful placement of a non-absorbable suture medial to the uterine vessels

Securing the suture anteriorly or posteriorly around the cervix

Confirmation of hemostasis and proper placement

The cerclage remains in place throughout pregnancy and delivery is usually done by cesarean section.

Advantages of Laparoscopic Cervical Cerclage

Minimally invasive with smaller incisions

Less blood loss and postoperative pain

Faster recovery and shorter hospital stay

Better anatomical placement at the internal os

Lower risk of infection compared to vaginal cerclage

Higher success rates in women with previous cerclage failure

Risks and Complications

Although generally safe, possible risks include:

Bleeding

Infection

Injury to adjacent organs (rare)

Uterine irritability or miscarriage (very rare with experienced surgeons)

Careful patient selection and surgical expertise significantly reduce these risks.

Pregnancy Outcomes

Studies have shown that laparoscopic cervical cerclage is associated with:

Improved fetal survival rates

Reduced preterm births

Prolonged gestational age

High success rates in women with poor obstetric history

Postoperative Care

Early mobilization and discharge within 24–48 hours

Routine antenatal follow-up

Ultrasound monitoring of cervical length

Avoidance of strenuous activity as advised

Conclusion

Laparoscopic cervical cerclage represents a major advancement in the management of cervical incompetence, offering superior anatomical support with minimal surgical trauma. When performed by experienced laparoscopic surgeons, it provides excellent pregnancy outcomes, especially in women with recurrent pregnancy loss or failed vaginal cerclage. This minimally invasive approach has become the preferred option for complex cases requiring cervical reinforcement.