How does laparoscopic cervical cerclage work?

In life, some women often suffer from habitual miscarriages and are prone to premature births. They are always unable to become pregnant and have children successfully. There are many reasons behind this. One possible reason is cervical insufficiency. In order to solve this problem, patients need to undergo cervical cerclage. The most popular method now is laparoscopic cervical cerclage. The operation process of this operation is introduced in detail below.

Laparoscopic cervical cerclage surgical steps:

Surgery can be done vaginally, abdominally, or laparoscopically.

There are many types of transvaginal surgical methods, such as the Shirodkar method, McDonald suture method, Cautifaris method, etc., among which the McDonald suture method is the most commonly used. McDonald's cervical cerclage or its modified method is a simple, safe and effective treatment method.

1. Expose the cervix.

2. Use a cervical forceps to hold the cervix and pull it downward. Use No. 7 or No. 10 double-strand silk or nylon thread to insert the needle at 11 o'clock, slightly below the attachment of the bladder, penetrate into the cervical mucosal muscular layer, and then exit at 10 o'clock.

3. Use cervical forceps to pull the cervix upwards, and continue to make bag-shaped sutures at 7-8 o'clock, 4-5 o'clock, and 1-2 o'clock on the cervix.

4. Pull the suture tight and tie a knot at the anterior fornix. The tightness of the ligature should be such that it can fit your fingertips.

Women with a history of cervical insufficiency who cannot undergo vaginal cerclage due to cervical injury may choose to undergo abdominal or laparoscopic cerclage. With the rapid development of laparoscopic technology, the laparoscopic cervical cerclage method appeared in 1998. The combination of minimally invasive technology and cerclage brings greater benefits to patients with cervical insufficiency and greatly reduces the pain of patients who need abdominal surgery. However, it should be emphasized that if vaginal delivery is required in the late stages of pregnancy, the sutures must be removed by laparoscopy or laparotomy. Otherwise, once labor begins, it will be very dangerous and emergency surgery will be required to remove the sutures.

Laparoscopic cerclage of the isthmus of the uterus during the non-pregnant period should be performed 3-7 days after the end of menstruation. The patient took the lithotomy position, and three puncture points were made at the umbilicus and both sides of the lower abdomen. The laparoscope and operating instruments were inserted for surgery. A uterine manipulator is placed through the vagina to push up the uterus, and under the microscope, monopolar electrocoagulation is used to cut the bladder peritoneal fold, push the bladder aside, and expose the isthmus of the uterus and the uterine blood vessels on both sides. Then a polypropylene cerclage band (Mersilene band) with needles at both ends is used for cervical cerclage. Change the suture needle from curved to straight, and insert the needle from front to back in the avascular area between the isthmus of the uterus and the uterine blood vessels. The needle exit point is still chosen between the isthmus of the uterus and the uterine blood vessels. After hysteroscopy to exclude the possibility that the cerclage band is located in the cervical canal, the Mersilene band is tightened to circumscribe the isthmus of the uterus and the knot is tied behind the isthmus of the uterus. Peritoneal reflection does not need to be sutured. It is best to place two cerclages in the isthmus to strengthen the support of the uterine isthmus.

If a cerclage is performed during pregnancy, there is no need to place a uterine manipulator in the uterine cavity. The specific operation method is as follows: The operation is performed using four puncture holes. Use an ultrasonic scalpel to cut the round ligament, and the assistant clamps the round ligament near the uterine stump, pulls the uterus to one side, exposes the broad ligament on the surgical side, cuts the avascular area of ​​the broad ligament to the level of the bladder peritoneal reflection, clamps and pushes up the cervix with a cervical clamp, cuts the bladder peritoneal reflection with an ultrasonic scalpel, pushes away the bladder, exposes the parauterine vascular bundle of the uterine isthmus, and uses the curved needle of the mersilene cerclage band to insert from the inside of the uterine vascular bundle and from the back to the front, and ties the knot in front of the uterine isthmus. After tying the knot, do not cut the cerclage band. Puncture the cerclage band needle from the inside of the blood vessel from front to back, bypass the back of the cervix, and then puncture from the inside of the blood vessel on the other side of the isthmus of the uterus from back to front to reach the front of the isthmus of the uterus, cerclage the isthmus of the uterus again, and complete the double cerclage of the isthmus of the uterus.