Robotic-assisted abdominal cerclage: a case report and literature review

We report a robotic-assisted, ultrasound-guided abdominal cerclage placement during pregnancy that resulted in term delivery, and review the current literature with respect to the efficacy of robotic-assisted transabdominal cerclage (RoboTAC) placement. The patient was a 25-year-old gravida 5 para 0-0-4-0 with cervical insufficiency who failed McDonald cerclage placement in two prior pregnancies, and presented at 13 weeks with a shortened (1.66 cm) cervical length. Placement of abdominal cerclage with robotic assistance under ultrasound guidance was performed at a teaching hospital. The main outcome measure was feasibility of RoboTAC placement in a gravid uterus under ultrasound guidance, and delivery of an infant ≥34 weeks of gestation with neonatal survival. Abdominal cerclage was safely and successfully placed at 13 weeks with robotic assistance. The patient had an otherwise uncomplicated antenatal course and was delivered via primary cesarean section at 38 weeks. Robotic-assisted abdominal cerclage can be considered for patients who require abdominal cerclage placement by skilled robotic surgeons.