Department of Obstetrics and Gynecology, University of South Florida/Morsani College of Medicine, Tampa, Florida.
Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida/Morsani College of Medicine Tampa, Florida.
Surg Technol Int. 2024 Jul 15;44:185-188. doi: 10.52198/24.STI.44.GY1794.
Preterm birth is the leading cause of perinatal and neonatal morbidity and mortality in the developed world. An important cause of preterm birth is cervical insufficiency, leading to membrane prolapse, premature rupture of membranes, and mid-trimester pregnancy loss. A cerclage can be placed vaginally or abdominally to treat cervical insufficiency. In cases of failed prior transvaginal cerclage (TVC), transabdominal cerclage (TAC) is the alternative. The procedure can be completed via laparoscopy or open approach. The suture is placed at the internal os giving greater structural support.1 In this article, we review the definition of cervical incompetence, we present the indications for TAC, we discuss the outcomes of minimally invasive TAC compared to open approach, and we review surgical tips and tricks for robotic assisted (RA) TAC placement that can be used prior to pregnancy or in early gestation. The included images delineate the surgical technique for safe placement of robotic assisted laparoscopic abdominal cerclage in the management of cervical insufficiency.
早产是发达国家围产期和新生儿发病率和死亡率的主要原因。早产的一个重要原因是宫颈机能不全，导致胎膜膨出、胎膜早破和中期妊娠流产。宫颈环扎术可经阴道或腹部进行，以治疗宫颈机能不全。在先前经阴道宫颈环扎术（TVC）失败的情况下，可选择经腹宫颈环扎术（TAC）。该手术可通过腹腔镜或开放手术完成。缝线放置在子宫颈内口，提供更大的结构支撑。1 在本文中，我们回顾了宫颈机能不全的定义，介绍了 TAC 的适应证，讨论了与开放手术相比微创 TAC 的结果，并回顾了用于在妊娠前或妊娠早期进行的机器人辅助（RA）TAC 放置的手术技巧和窍门。所包括的图像描绘了用于管理宫颈机能不全的机器人辅助腹腔镜腹部环扎术的安全放置的手术技术。
