A laparoscopic abdominal cerclage is a minimally invasive method of removing the uterus through small cuts on the abdomen, with the use of laparoscopic instruments. The procedure can either be done before pregnancy or in the first few weeks of the pregnancy. It is usually offered when one has had two or more failed transvaginal cervical cerclage procedures i.e. a miscarriage occurred in spite of having the transvaginal cerclage done.
Like with the open abdominal cerclage, after this procedure you will only be able to have a delivery by Caesarean section, but the stitch is not removed as it is not harmful to the body and so it can be used for future pregnancies.
The advantages of laparoscopic abdominal cerclage over open abdominal cerclage are the reduced amount of contact with the pregnant uterus, less pain, and a faster recovery time. It is also an easier procedure to do when one is not yet pregnant.
Before the procedure, some tests will be done to check your blood level, heart and kidney functions, blood group, and blood clotting function. If an abnormality is detected or if you have been known to have a previous illness, you might need to be seen by another doctor to be cleared for surgery.
This procedure can only be done under general anaesthesia.
Thin, rodlike instruments are passed through small skin cuts into the abdomen. They are attached to a camera and the images are projected on a screen, so the surgeon is able manipulate them to remove the fibroids under direct visualization. A special gas is first introduced into the abdominal cavity, to create space and improve the surgeon’s view. Once this is done, the stitch can now be placed on the lower part of the uterus, just above the cervix. The gas is then removed from the abdomen before the skin is closed up.The procedure takes about two hours.
Afterwards, you will need to be on admission for 3 to 4 days, to allow your wound to heal and to monitor you and your baby (if you are pregnant) for a while. It is not uncommon to experience some vaginal bleeding (spotting), and mild cramps after the procedure, which will stop in a day or two. You will be placed on oral antibiotics, analgesics, and tocolytics (a drug to prevent the uterus from contracting). Subsequently you will be seen after a few days to check that the stitch is intact, then either weekly or every two weeks.