OBJECTIVE To demonstrate a simple, stepwise strategy for robot-assisted abdominal cerclage placement before pregnancy. DESIGN Demonstrative video presentation. Surgical footage surrounding a case report is used to describe a four-step technique for robot-assisted abdominal cerclage placement in women with recurrent pregnancy loss or other anatomic variants before pregnancy. This video article was reviewed by the Investigational Review Board and further investigation was waived because the study was "not considered human subject research." SETTING Tertiary medical center. PATIENT(S) A 38-year-old G4P0220 (Gestations: 4, Term deliveries: 0, Preterm deliveries: 2, Abortions: 2, Living children: 0) with a history of two second trimester losses who had failed a prior history-indicated transvaginal cerclage (Fig. 1). INTERVENTION(S) The patient underwent an uncomplicated robot-assisted abdominal cerclage using a four-step strategy: Step 1, create the bladder flap; Step 2, identify pertinent anatomy; Step 3, place the cerclage; and Step 4, hysteroscopy. MAIN OUTCOME MEASURE(S) Intraoperative technique presenting a four-step method to ensure successful robot-assisted abdominal cerclage placement. RESULT(S) Robot-assisted abdominal cerclage is a safe, viable alternative to traditional abdominal cerclage placed via laparotomy. This video outlines four critical steps to facilitate placement and decrease patient morbidity. This patient did well operatively without increased blood loss or operative time and was discharged home on postoperative day 1. She went on to have a successful future pregnancy and currently is scheduled for an elective cesarean section at term. CONCLUSION(S) Abdominal cerclages significantly improve pregnancy and neonatal outcomes in women who previously have failed transvaginal cerclage. Robot-assisted abdominal cerclage placement allows a minimally invasive approach with enhanced dexterity and better visualization for the surgeon compared with conventional laparoscopy or laparotomy, as well as decreased pain and shorter recovery time for patients. This video demonstrates placement of a robot-assisted abdominal cerclage in a patient with recurrent pregnancy loss using a simple four-step strategy to ensure successful, correct, and easy placement. To our knowledge, this is the first video demonstrating a stepwise approach to robot-assisted abdominal cerclage placement.

中文翻译：

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怀孕前机器人辅助腹部环扎术的四步策略

目的展示一种简单的、逐步的策略，用于在怀孕前放置机器人辅助的腹部环扎术。设计演示视频演示。围绕病例报告的手术录像用于描述机器人辅助腹部环扎术的四步技术，用于在怀孕前反复流产或其他解剖变异的妇女。该视频文章由调查审查委员会审查，并放弃了进一步调查，因为该研究“不被视为人类受试者研究”。设置三级医疗中心。患者 38 岁 G4P0220（妊娠：4，足月分娩：0，早产：2，流产：2，活儿：0），有两个中期妊娠丢失史，既往史失败-表示经阴道环扎（图 1）。干预措施 患者接受了简单的机器人辅助腹部环扎术，采用四步策略： 步骤 1，创建膀胱瓣；第二步，确定相关的解剖结构；第三步，放置环扎；第 4 步，宫腔镜检查。主要观察指标 术中技术采用四步法来确保机器人辅助腹部环扎术的成功放置。结果 机器人辅助的腹部环扎术是通过剖腹手术放置的传统腹部环扎术的安全、可行的替代方案。该视频概述了促进放置和降低患者发病率的四个关键步骤。该患者手术效果良好，没有增加失血量或手术时间，并在术后第 1 天出院回家。她继续成功怀孕，目前计划在足月进行择期剖宫产。结论（S）腹部环扎术可显着改善先前经阴道环扎术失败的妇女的妊娠和新生儿结局。与传统的腹腔镜手术或开腹手术相比，机器人辅助的腹部环扎术可以采用微创方法，为外科医生提供更高的灵活性和更好的可视化，以及减少患者的疼痛和更短的恢复时间。该视频演示了使用简单的四步策略在复发性流产患者中放置机器人辅助腹部环扎术，以确保成功、正确和轻松放置。据我们所知，这是第一个展示机器人辅助腹部环扎术的逐步方法的视频。