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Updated: Mar 29, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Total cervical occlusion: A solution after cervico-isthmic cerclage failure
Déborah Couet1,2, Anne-Gaëlle Pourcelot1,2, Claire Szmulevicz1,2
1Department of Gynecology and Obstetrics, CHU de Bicêtre, AP-HP, DMU2, Le Kremlin-Bicêtre, France.
Objective:
Spontaneous preterm birth is mainly caused by cervical incompetence. Cervical cerclage is the gold standard for preventing mid-trimester losses and preterm deliveries. If cervical cerclage fails, cervico-isthmic cerclage may be indicated. This procedure can be performed via an abdominal or vaginal approach and allows for a neonatal survival rate of around 90%. If a cervico-isthmic cerclage fails, there is no gold standard. Total cervical occlusion (TCO) could be an option. The present study aimed to analyze the efficacy of TCO using the Saling technique in cases where cervico-isthmic cerclage has failed.
Methods:
Here, we present the surgical technique and our results in a small series of five cases. This single-center study was conducted between 2009 and 2023, involving women who underwent a TCO after the first trimester of pregnancy.
Results:
Five women underwent this TCO: three for late miscarriage after a cervico-isthmic cerclage during a previous pregnancy from which no child was born, and two for threatened late miscarriage in the current pregnancy (median gestational age: 17 and 21.2 weeks). All of the women had already undergone a cervico-isthmic cerclage.
Conclusion:
This occlusion was effective in prolonging pregnancy for all five women. The mean gestational age at delivery was 32.5 weeks (range: 24.1-37.2 weeks). On average, TCO prolonged pregnancy by 11.7 weeks (minimum 3, maximum 16).
