title: Laparoscopic cervicoisthmic cerclage: technique and systematic review of the literature.
abstract: OBJECTIVE
  To report on and review the outcome after laparoscopic cervicoisthmic cerclage (LCC) and robotic-assisted laparoscopic cervicoisthmic cerclage.
  
  
  METHODS
  We reported on 4 cases of LCC and conducted a systematic review of the literature up to May 2012 to identify obstetric outcomes after LCC and robotic-assisted LCC.
  
  
  RESULTS
  The median age of our series was 35 years (range: 31-41) with median previous pregnancies 3.5 (2-5). All 4 women had successful obstetric outcomes with a median gestational age at delivery of 37 weeks (range: 36-38). The systematic review identified 25 studies (162 women underwent LCC and 3 had robotic-assisted LCC). In the interval LLC studies, the median age was 33 years (range: 22-42); with a median gestational age at delivery of 37 weeks (range: 34-38). For prophylactic LCC, the median age was 31 years (range: 27-41); with a gestational age at delivery of 37 weeks (range: 19-39). Two of the three robotic-assisted LCC procedures were done prophylactically. The median age was 27 years (range: 23-37) with a median gestational age at delivery of 37 weeks (range: 35-38).
  
  
  CONCLUSIONS
  LCC is feasible during and in between pregnancies as well as in congenitally malformed uteri. Current evidence suggests that LCC might be of benefit in selected cases of cervical insufficiency with short cervices.
authors.affiliation: Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Maria Fidela
authors.initials: MF
authors.lastname: Paraiso
authors.forename: Katherine
authors.initials: K
authors.lastname: Rodewald
authors.forename: Tristi
authors.initials: T
authors.lastname: Muir
authors.forename: Faten
authors.initials: F
authors.lastname: Abdelhafez
authors.forename: Noam
authors.initials: N
authors.lastname: Lazebnik
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bedaiwy
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D055815:Young Adult