ABSTRACT
Background
For women who undergo fertility-sparing treatment for early cervical cancer, transabdominal cerclage (TAC) may be considered to prevent adverse obstetric outcomes due to cervical insufficiency. Laparoscopic-TAC (LPS-TAC) is now preferred over conventional transabdominal approaches because of decreased pain and bleeding, shorter hospitalisation and quicker recovery. However, a systematic, precise approach to performing LPS-TAC during pregnancy is necessary to overcome the lack of uterine manipulation and minimise complications such as bleeding and pregnancy loss.
Objectives
To demonstrate the surgical technique of post-conceptional LPS-TAC.
Participant
A 33-year-old woman with a history of FIGO stage IA1 squamous cervical cancer treated with fertility-sparing surgery. She had suffered a foetal loss after an emergency Caesarean section at 28 weeks because of uterine rupture. In her next pregnancy she presented at 10 weeks gestation with an ultrasound diagnosis of cervical shortening (14mm).
Intervention
The patient underwent LPS-TAC at a tertiary referral center. The operating time was 51 minutes, and blood loss was minimal. Intraoperative transvaginal ultrasound was used to guide the cerclage placement. No perioperative complications occurred; the hospital stay was two days. Elective C-section was performed at 34+6 weeks with hysterotomy above the tape, which was left in situ.
Conclusions
LPS-TAC during pregnancy represents a feasible minimally invasive option for selected patients with cervical insufficiency, particularly those with a history of prior cervical surgery. Intraoperative ultrasound may assist in identifying the internal cervical os, facilitating safe tape placement and minimising the risk of membrane injury during pregnancy.
What is New?
Intraoperative ultrasound guidance may support safe identification of the internal cervical os and optimal tape placement when performing LPS-TAC during pregnancy in patients with previous fertility-sparing treatment for cervical cancer.
