Alzamora Schmatz Maria C, Sridhar Shobha, Billow Megan
Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, Ohio.
Minimally Invasive Gynecologic Surgery, Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, Ohio.
Fertil Steril. 2025 Jul 5. doi: 10.1016/j.fertnstert.2025.06.044.
Cervical insufficiency is a significant cause of second-trimester loss and preterm birth. Transabdominal cerclage is indicated after failed transvaginal cerclage or anatomical factors that make a vaginal approach technically difficult-such as müllerian anomalies, prior cervical surgery, or cervical duplication. In patients with müllerian anomalies undergoing a cerclage placement, it is critical to properly identify the anatomy for surgical planning and patient counseling of the cerclage method.
To describe transabdominal cerclage indications and surgical technique and to illustrate a needleless laparoscopic abdominal cerclage placement in a patient with a complete septate uterus and duplicated cervices and important related considerations.
Case report.
This case describes a 33-year-old G2P0201 female, with a history of undergoing a loop electrosurgical excision procedure and longitudinal vaginal septum resection, and who was previously misdiagnosed with a didelphic uterus and duplicated cervices. She had a failed history-indicated transvaginal cerclage placed around the cervix connected to the gravid hemicavity during her second pregnancy and was referred to our practice for transabdominal cerclage placement. A preoperative magnetic resonance imaging scan was performed. (The patient(s) included in this video gave consent for publication of the video and posting of the video online including social media, journal website, scientific literature websites [such as PubMed, ScienceDirect, Scopus, etc.] and other applicable sites.) INTERVENTION: Needleless laparoscopic transabdominal cerclage.
Preoperative workup, imaging, and surgical technique.
Magnetic resonance imaging scan revealed a complete septate uterus with duplicated cervices. A needleless laparoscopic transabdominal cerclage was placed after careful dissection of the uterine vessels at the level of the internal cervical os and creation of a tunnel medial to them. Nonabsorbable, braided polyester suture was used.
Transabdominal cerclage is a feasible alternative in patients with congenital uterine anomalies, as a transvaginal approach might increase the risk of failure. Accurate diagnosis through advanced imaging, multidisciplinary consultation, and individualized surgical planning are key to optimizing reproductive outcomes.
宫颈机能不全是孕中期流产和早产的重要原因。经腹宫颈环扎术适用于经阴道宫颈环扎术失败或因解剖因素导致经阴道手术操作困难的情况，如苗勒管异常、既往宫颈手术或宫颈重复畸形。对于接受宫颈环扎术的苗勒管异常患者，正确识别解剖结构对于手术规划和向患者讲解宫颈环扎方法至关重要。
描述经腹宫颈环扎术的适应证和手术技术，并举例说明在一名完全纵隔子宫合并双宫颈患者中进行无针腹腔镜经腹宫颈环扎术及重要的相关注意事项。
病例报告。
本病例描述了一名33岁、孕2产0、既往有宫颈环形电切术和阴道纵隔切除术史的女性，此前被误诊为双子宫和双宫颈。她在第二次妊娠期间进行的经阴道宫颈环扎术失败，该环扎术围绕与妊娠半宫腔相连的宫颈进行，后被转诊至我院进行经腹宫颈环扎术。术前行磁共振成像扫描。（本视频中的患者已同意发布该视频并在包括社交媒体、期刊网站、科学文献网站[如PubMed、ScienceDirect、Scopus等]及其他适用网站在内的网络上发布该视频。）干预措施：无针腹腔镜经腹宫颈环扎术。
术前检查、影像学检查及手术技术。
磁共振成像扫描显示为完全纵隔子宫合并双宫颈。在仔细解剖宫颈内口水平的子宫血管并在其内侧创建隧道后，进行了无针腹腔镜经腹宫颈环扎术。使用了不可吸收的编织聚酯缝线。
对于先天性子宫异常患者，经腹宫颈环扎术是一种可行的替代方法，因为经阴道途径可能会增加失败风险。通过先进的影像学检查进行准确诊断、多学科会诊以及个体化的手术规划是优化生殖结局的关键。
