Laparoscopic abdominal cerclage at 15 weeks of gestation after trachelectomy: a step-by-step surgical video

To demonstrate the surgical technique of laparoscopic abdominal cerclage at 15 weeks of gestation in a patient with a history of radical trachelectomy.

Video article with intraoperative narration and key surgical highlights.

A 37-year-old woman, gravida 2 para 0, had a history of radical trachelectomy for early-stage cervical cancer. After in vitro fertilization, she presented at 15 weeks of gestation with a short cervix (17 mm) and insufficient cervical tissue for vaginal cerclage.

Laparoscopic abdominal cerclage was performed at a tertiary academic center specializing in minimally-invasive gynecologic surgery.

The patient delivered a healthy infant via cesarean section at 36 weeks after premature rupture of membranes. The cerclage was left in place for future pregnancies.

A four-step laparoscopic approach was used: abdominal entry via the Hasson technique and trocar placement adapted to the gravid uterus, dissection of the vesicouterine peritoneum and broad ligaments to identify the uterine arteries, placement of a nonabsorbable suture medial to the uterine arteries at the isthmus level, and suture fixation using a Roder knot and peritonealization. Tips for managing intraoperative bleeding and optimizing exposure are discussed.

Laparoscopic abdominal cerclage during pregnancy may be considered a feasible and relatively safe approach in selected high-risk patients. This video provides a clear and structured guide for surgeons managing posttrachelectomy pregnancies.