Laparoscopic transabdominal cerclage in a pregnant woman after fertility-sparing treatment for early-stage cervical cancer: an operative technique in ten steps

Abstract

Introduction: Fertility-sparing treatments are increasingly used in patients with early-stage cervical cancer. The residual shortened cervix might increase the risk of preterm birth. When a vaginal cerclage is not technically feasible, a laparoscopic transabdominal cerclage (LAC) could be offered before or after conception. In this article, we show how to safely perform a post-conceptional LAC in patients with insufficient residual cervical length for vaginal cerclage. Methods: A 34-year-old patient in the twelfth week of gestation who previously underwent repeated conisation for cervical cancer FIGO stage IA1 in 2021 was referred for cervical stenosis, which required a subsequent vaginal tracheoplasty. She became pregnant 3 months later. Ultrasound monitoring of the cervix showed a 15 mm cervical length. A step-by-step LAC in a pregnant woman was performed. Results: The Doppler velocimetry of the uterine arteries at the end of the procedure was normal. No intraoperative or postoperative complications were reported. The estimated blood loss was 100 mL and the total operative time of 120 min. The patient was discharged on the third postoperative day. A caesarean section was performed at 36 weeks of gestation for spontaneous contractions with excellent obstetric (male, 2860 gr) and neonatal outcomes. Conclusion: LAC in pregnancy, although made more difficult due to the size of the uterus, is a safe and feasible procedure combining the advantages of minimally invasive surgery with excellent obstetric result. Learning Objective: In this video is shown how to perform a post-conceptional transabdominal laparoscopic cerclage in a young woman with no sufficient cervical length for a vaginal approach.