title: Laparoscopic transabdominal cervical cerclage: a 6-year experience.
abstract: BACKGROUND
  Cervical cerclage has been used as a treatment for cervical insufficiency for over 60 years. Transabdominal cerclage is indicated for cervical insufficiency not amenable to a transvaginal procedure, or following previous failed vaginal cerclage. A laparoscopic approach to abdominal cerclage offers the potential to reduce the morbidity associated with laparotomy.
  
  
  OBJECTIVE
  To evaluate the obstetric outcome and surgical morbidity of laparoscopic transabdominal cerclage.
  
  
  METHODS
  An observational study of consecutive women undergoing laparoscopic transabdominal cerclage from 2007 to 2013 by a single surgeon (AA). Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix. The primary outcome was neonatal survival. Secondary outcomes were delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated.
  
  
  RESULTS
  Sixty-four women underwent laparoscopic transabdominal cerclage during the study period. Three women underwent cerclage insertion during pregnancy; the remaining 61 were not pregnant at the time of surgery. Thirty-five pregnancies have been documented to date. Of those, 24 were evaluated for the study. The remaining cases were either early miscarriages, ectopic pregnancies or are still pregnant. The perinatal survival rate was 95.8% with a mean gestational age at delivery of 35.8 weeks. Eighty-three per cent of women delivered at ≥34 weeks gestation. There was one adverse intra-operative event (1.6%), with no postoperative sequelae.
  
  
  CONCLUSIONS
  Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. Success rates compare favourably to the laparotomy approach.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Vic., Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Ades
authors.forename: James
authors.initials: J
authors.lastname: May
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Cade
authors.forename: Mark P
authors.initials: MP
authors.lastname: Umstad
mesh_terms: D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*
keywords: cerclage; cervical; cervical incompetence; labour; laparoscopic surgery; premature; preterm birth