This video demonstrates Laparoscopic cervical cerclage: a minimally invasive solution for cervical incompetence by Dr. R K Mishra at World Laparoscopy Hospital. Cervical incompetence is a condition in which the cervix (the lower part of the uterus) begins to open too soon during pregnancy, resulting in a risk of preterm labor or miscarriage. Traditional treatment for cervical incompetence involves the placement of a cervical cerclage, which is a surgical stitch that holds the cervix closed. However, this procedure has been associated with several potential risks and complications, such as infection, bleeding, and preterm rupture of the membranes.
In recent years, laparoscopic cervical cerclage has emerged as a minimally invasive alternative to traditional cervical cerclage. This innovative procedure involves the placement of a cerclage stitch around the cervix through tiny incisions in the abdomen, using specialized instruments and a laparoscope, which is a thin, flexible tube with a camera attached to it. This approach provides several advantages over the traditional procedure, such as improved visualization of the cervix, reduced risk of infection and bleeding, and faster recovery.
Laparoscopic cervical cerclage can be performed either before pregnancy or during early pregnancy, depending on the individual case. The procedure is typically done under general anesthesia, and patients can usually go home the same day or the next day after the surgery. Most women are able to resume normal activities within a few days to a week after the procedure.
The success rates of laparoscopic cervical cerclage have been shown to be comparable to those of traditional cervical cerclage, with a lower risk of complications. In addition, this procedure can be used in women who have had multiple previous cervical cerclages or who have an abnormal cervix that makes the traditional procedure difficult or impossible.
Overall, laparoscopic cervical cerclage offers a safe and effective alternative to traditional cervical cerclage for the management of cervical incompetence. This minimally invasive approach provides several benefits, including reduced risk of complications, faster recovery, and improved outcomes for both the mother and the baby. If you are concerned about cervical incompetence or have been advised to undergo cervical cerclage, it is important to talk to your doctor about all of your options, including laparoscopic cervical cerclage.
00:00Hello friends this is a case of laparoscopic cervical circulation surgery this patient
00:06has previous three time second trimester abortion and the MRI has confirmed that there was cervical
00:15incompetence so first step is uterus should be retroverted and with the harmonic or monopolar
00:22seizures you can just cut the plutonium of the UV fold 33 centimeter either side from
00:29the midline
00:45after separating the plutonium with the blunt dissection you can little bit separate the
00:52bladder only of the cervical part of the bladder has to be separated the vaginal part doesn't
00:58need to be reflected left hand should make a lateral window and slowly you can separate
01:04it taking care that it should be cranial traction and it should be mostly blunt left hand has
01:16a blunt atraumatic rasper and now with the suction you will do the little lateralization of the
01:22bladder pillar in this patient the left side the uterine artery was little more tortuous
01:31and more nearer as we can see that this is the left side of uterine artery so now we have
01:42little bit change the our strategy normally we put the needle always from posterior to anterior
01:49but this time Marceline tape we will put anterior to posterior on the left side and posterior to
01:54anterior on the right side so this is the Marceline tape which we have introduced just with the five
02:00millimeter pole and then left side just taking care that with the Maryland little traction over the uterine
02:14uterine is given and then needle is introduced from anterior to posterior and assistant with the uterine
02:23manipulator will keep the uterus steady and then needle is taken out we have already given one little
02:30coagulation with the bipolar to the point that is two centimeter above the arc of uterus cycle ligament
02:36so that there will be absolutely no bleeding and then this tape is pulled posteriorly after that
02:49anteriorly we will go from below up and this tape is taken on the right side from posterior to anterior
02:57so we can see here this is the tape on the left and this tape on the right and bilateral symmetrically
03:11you can pull the needle either side to just bring the tape in contact with the surface after that extra
03:24this is we can see the tape is above the arc of uterus cycle ligament and then the needle has to be
03:36removed little suction just few drop of blood is there that can be sucked irrigated and cleaned
03:47so now it is both the needle has to be removed we can hold both the needle together with the
03:54left hand instrument and with the harmonic you can cut the needle cutting the tape with the harmonic
04:01near the needle has advantage that both the tape will stick together due to melting point of the
04:07harmonic and after that you can take it out together with the 5 mm port so because it will melt because
04:16basically it is Marceline Marceline is a type of polyester so it is stick together and now you can
04:24pull both the needle together with the 5 mm port and it will be taken out
04:37after that you can tie a surgeon's knot first time double wrap
04:43followed by two opposite alternating wrap it should be not very tight just moderate second time also we have taken double wrap but only single is enough so this is c reverse c and again c
05:12and you can tie the knot
05:18after that you can cut the excess of the tape again if you cut both the tape together
05:41then you can stick together
05:49and then you will take a bite with the vicryl on both the tip of both the tape together
05:55and then here we have used a dundee jamming knot
06:04you can take a bite and then go through the loop
06:09this is dundee jamming knot and pull the loop and automatically it will get locked
06:22after that it can fix again to the cervical fascia at 12 o'clock position and you can take a bite
06:36together with the tape so that it will be fixed advantage is that it will not go near the bladder
06:44posteriorly already utero cycle is supporting it
06:48and during hysterectomy during the caesarean if you want to
06:53remove it it will be found the knot will be found at 12 o'clock position
06:58and now again it is locked
07:00after that we will not cut with this suture the same suture will continuously close the peritonium
07:11so this tape will be completely covered with the peritonium
07:24so this is continuous suturing and this is continuous suturing
07:38closing the peritonium
07:49closing the peritonium
07:54So, continuous switch ring is very easy and it should just hide the entire tape in the
08:21petronium fold at this point of time you can remove the uterine manipulator it is not
08:29necessary. So, that petronium will remain relax and it can be easily closed.
08:44Once you reach to the left side then you can close here the petronium with the Aberdeen
08:54termination. Only 3 port is there and you can use all the 3 5 mm because you can introduce
09:12the tape by the through the wound itself with the back of the needle and tape is not thick
09:20it will go easily with the 5 mm port. So, now it is reached to the left end and then
09:33you can enter loop within loop this is final closure starts now and this is called Aberdeen
09:42termination. You may tie surges not but Aberdeen will be easy in this situation. So, this is
09:57loop within loop it is locked and finally, the needle will be taken out one more loop within
10:14loop you have to pull the non needle end and then finally, needle is out.
10:37The needle will come out easily with the 5 mm port and then little suction irrigation just
10:43few drop of blood is there which can be cleaned. So, thank you very much for watching this is
10:51a simple case of the cervical laparoscopic surplus for the cervical incompetence. Thank
