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This video demonstrates Laparoscopic Cervical Cerclage With Myomectomy performed by Dr. R.K. Mishra at World Laparoscopy Hospital. Laparoscopic 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.

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 and transabdominal approaches both 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

Cervical cerclage is a surgical procedure performed to prevent preterm birth in women with cervical insufficiency. When combined with myomectomy—the removal of uterine fibroids—this procedure becomes technically challenging but can be performed safely with laparoscopic techniques. Laparoscopic cervical cerclage with myomectomy represents a minimally invasive approach, offering faster recovery, less postoperative pain, and reduced risk of complications compared to traditional open surgery.

Indications
Laparoscopic cervical cerclage is typically indicated in women with:

History of recurrent mid-trimester pregnancy losses due to cervical insufficiency

Structural cervical abnormalities

Large submucosal or pedunculated uterine fibroids (myomas) affecting fertility or pregnancy outcomes

Combining this with myomectomy is considered when fibroids are located near the cervix or uterine cavity, potentially complicating pregnancy or cerclage placement.

Preoperative Preparation

Detailed pelvic ultrasound and MRI to assess fibroid location, size, and vascularity.

Preoperative counseling regarding risks and benefits of combined surgery.

Routine labs and anesthesia assessment.

Planning for laparoscopic access ports to ensure optimal visualization of the uterus and cervix.

Surgical Technique

Patient Positioning and Port Placement

The patient is placed in a lithotomy position with Trendelenburg tilt.

Standard laparoscopic ports are inserted: usually one umbilical 10 mm port for the camera and three 5 mm accessory ports.

Myomectomy

Fibroids are identified and excised using laparoscopic instruments.

Hemostasis is achieved with bipolar coagulation or suture techniques.

The uterine wall is carefully repaired to maintain integrity for future pregnancy.

Cervical Cerclage Placement

The cervix is exposed laparoscopically.

A non-absorbable suture (such as Mersilene tape) is placed around the cervico-isthmic junction.

The suture is tied securely, ensuring adequate cervical support.

Laparoscopic visualization ensures proper placement and avoids injury to adjacent structures.

Completion and Recovery

Hemostasis is confirmed, and ports are closed.

Patients typically have a shorter hospital stay and resume normal activity faster than open surgery.

Advantages of Laparoscopic Approach

Minimally invasive with smaller incisions

Reduced postoperative pain and faster recovery

Excellent visualization of pelvic structures

Precise excision of fibroids and accurate cerclage placement

Lower risk of adhesion formation compared to open surgery

Postoperative Care

Monitor for bleeding or infection

Avoid heavy lifting and strenuous activity for several weeks

Regular follow-up with ultrasound to monitor uterine healing and cervical integrity

Conclusion
Laparoscopic cervical cerclage combined with myomectomy is a safe and effective approach for women with cervical insufficiency complicated by uterine fibroids. It requires advanced laparoscopic skills and thorough preoperative planning but offers significant benefits in terms of recovery, fertility preservation, and pregnancy outcomes.