29 Interval robotic-assisted laparoscopic transabdominal cerclage: Simplifying the complex

The objective of this video is to illustrate the steps of an interval robotic-assisted laparoscopic transabdominal cerclage with minimal dissection. Cervical cerclage is shown to reduce pregnancy loss and improve pregnancy outcomes in women with poor obstetric history related to cervical insufficiency (Moawad 2018). A transabdominal approach is indicated for women with abnormal cervical anatomy or history of a prior failed transvaginal cerclage. Obstetric outcomes including rate of preterm birth and PPROM are improved with transabdominal cerclage compared to transvaginal cerclage, and the success rate is as high as 85-90% (Moawad 2018, Davis 2000, and Zaveri 2002). Compared with laparotomy, a laparoscopic approach is associated with improved success and decreased surgical morbidity (Ades 2005). Robotic-assisted laparoscopic approach may further improve outcomes and reduce surgical complications while reducing technical challenges (Tyan 2019). In this video, we present a non-gravid patient undergoing robotic-assisted laparoscopic transabdominal cerclage. Key surgical steps are illustrated:1Identification of key anatomy2Dissection of vesicouterine reflection3Introduction of merseline tape4Anterior-posterior needle pass medial to the uterine vessels at the level of the internal os5Tying of a posterior knot. Interval robotic-assisted laparoscopic transabdominal cerclage placement is a feasible and effective treatment for cervical insufficiency and can be accomplished with minimal dissection.