title: Robot-Assisted Abdominal Cerclage During Pregnancy.
abstract: OBJECTIVE
  Cervical insufficiency is a difficult condition to diagnose and can lead to preterm birth, miscarriage, or perinatal infant morbidity and mortality. We conducted this retrospective case study and literature review to evaluate the safety and efficacy of robot-assisted abdominal cerclage during pregnancy.
  
  
  METHODS
  We conducted a case series and a systematic review that included patients who underwent robot-assisted abdominal cerclage during pregnancy from January 2010 through March 2016.
  
  
  RESULTS
  Six patients met the criteria for the case series. Median age was 34 years (range, 28-37) at the time of the procedure. In 5 cases, the indication for transabdominal cerclage was a failed vaginal cerclage in a previous pregnancy, whereas a scarred and shortened cervix caused by a previous dilatation and curettage-induced cervical laceration was the indication in the remaining case. Median operating time was 159.5 minutes (range, 124-204), and median estimated blood loss was 25 mL (range, 10-25). No surgeries were converted to laparotomies; all patients were discharged on postoperative day 1. The median gestational age at delivery was 37.5 weeks (range, 22-39). Five patients delivered between 36 and 39 weeks. No patients had chorioamnionitis or preterm premature rupture of membranes. One patient went into preterm labor at 22 weeks, and the cerclage was removed via minilaparotomy. Eight articles met the criteria for systematic review. Sixteen patients underwent robot-assisted abdominal cerclage during pregnancy. Median age was 31.5 years (range, 25-37). The major indication in most articles was previous failed transvaginal cerclage. The median gestational ages at time of procedure and delivery were 12 weeks (range, 10-15) and 37 weeks (range, 33-39), respectively.
  
  
  CONCLUSIONS
  Robot-assisted abdominal cerclage is safe and effective during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Texas, USA.
authors.forename: Burak
authors.initials: B
authors.lastname: Zeybek
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Bridgeport, Connecticut, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hill
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Gulden
authors.initials: G
authors.lastname: Menderes
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Texas, USA.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Borahay
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Texas, USA.
authors.forename: Gokhan Sami
authors.initials: GS
authors.lastname: Kilic
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D002581:Uterine Cervical Incompetence / Q000601:surgery*
keywords: Abdominal cerclage; Cervical insufficiency; Preterm birth; Robotic