Objective

To demonstrate the step-by-step surgical technique of robotic-assisted transabdominal cerclage, highlighting a new posterior compartment approach.

Design

Stepwise explanation of a surgical technique using surgical video.

Setting

The procedure was performed at the Obstetrics and Gynecology Department, Hospital Vall d'Hebron in Barcelona, Spain, a tertiary medical center. The local institutional review board considers that case reports are exempt from research approval.

Patient(s)

A 26-year-old non-pregnant patient, with a history of cervical incompetence, three second-trimester losses, and vaginal cerclage failure during her previous pregnancy.

Intervention(s)

Robotic-assisted transabdominal cerclage placement was performed. An 8-mm, 30° scope; monopolar scissors; and Maryland bipolar graspers were used. A uterine manipulator was used for better exposure. First, a bladder flap was created, and the uterine vessels were identified and skeletonized. Next, a window between the uterine vessels and the uterine cervix at the level of the cervical-isthmic junction was created bilaterally. At the posterior compartment, the dissection of the root of the uterosacral ligaments was carefully performed. A retrocervical pocket was created with monopolar scissors and sharp dissection. The procedure was finished with the Mersilene tape placement. First, the tape was passed through the window created in the right broad ligament, with a posterior-to-anterior direction, the retro cervical pocket, and finally through the left broad ligament. The knot was placed anteriorly and reperitonization was performed. In addition to this operation, robotic-assisted transabdominal cerclage was successfully performed in another six patients with good surgical and obstetrics outcomes.

Main outcome measure(s)

Intraoperative technique to ensure successful robot-assisted abdominal cerclage placement.

Result(s)

The patient became pregnant six months following the robotic-assisted transabdominal cerclage. Her pregnancy was closely followed up at the High-Risk Obstetric Unit, and she had no complications during pregnancy. An elective cesarean section was performed at 36 weeks with a healthy newborn baby that was discharged with the mother three days after delivery.

Conclusion(s)

The development of a retro cervical pocket during robotic-assisted transabdominal cerclage can be performed safely and effectively. It may help prevent displacement of the Mersilene tape during endoscopic knotting.

中文翻译：

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复古宫颈隧道，以确保机器人辅助经腹环扎术的正确放置

客观的

展示机器人辅助经腹环扎术的分步手术技术，突出一种新的后房室入路。

设计

使用手术视频逐步解释手术技术。

环境

该手术在西班牙巴塞罗那的 Vall d'Hebron 医院妇产科进行，这是一家三级医疗中心。当地机构审查委员会认为病例报告免于研究批准。

耐心）

一名 26 岁的非妊娠患者，有宫颈机能不全病史，妊娠中期流产 3 次，上次妊娠期间阴道环扎失败。

干预措施

进行了机器人辅助的经腹环扎术。8 毫米、30° 范围；单极剪刀；和马里兰州双极抓手被使用。子宫操纵器用于更好的暴露。首先，创建一个膀胱瓣，并确定子宫血管并进行骨骼化。接下来，在子宫颈峡部交界处水平的子宫血管和子宫颈之间创建一个窗口。在后室，仔细解剖子宫骶韧带根部。用单极剪刀和锐器解剖创建了一个颈后袋。该过程以 Mersilene 胶带放置完成。首先，胶带穿过在右阔韧带上形成的窗口，从后到前的方向，后颈袋，最后通过左阔韧带。结被放置在前面并进行再腹膜化。除此手术外，另外 6 名患者成功进行了机器人辅助经腹环扎术，手术和产科结果良好。

主要观察指标）

确保机器人辅助腹部环扎术放置成功的术中技术。

结果）

患者在机器人辅助经腹环扎术后六个月怀孕。她的怀孕在高危产科病房接受了密切随访，她在怀孕期间没有出现并发症。一名健康的新生儿在 36 周时进行了选择性剖宫产，该婴儿在分娩三天后与母亲一起出院。

结论

在机器人辅助的经腹环扎术期间开发复古宫颈袋可以安全有效地进行。它可能有助于在内窥镜打结过程中防止 Mersilene 胶带移位。