| Autor: |
Guan, X, Latif, NFB Abdul, Guan, Z, Asare, S |
| Zdroj: |
Journal of Minimally Invasive Gynecology; 2024 Supplement, Vol. 31 Issue 11, pS39-S39, 1p |
| Abstrakt: |
To demonstrate the surgical techniques for robotic-assisted abdominal cerclage in patients with bicornuate uteri complicated by recurrent pregnancy loss. Case report. Patient in dorsal lithotomy position. Patient is a 22-year-old G2P0020 with a history of recurrent pregnancy loss. The MRI report noted a "...bicorporeal uterus with duplication of the uterine body, resulting in two markedly divergent uterine horns that are fused at the isthmus...". The surgery began with the bladder dissected from the lower uterine segment and both uteri using monopolar scissors. The bicornuate uterus prompted the surgeon to dissect a wider circumference. Bilateral uterine vessels were skeletonized and exposed anteriorly using blunt dissection and monopolar scissors. The final result creates a landmark medial to the right uterine vessels at the level of the internal cervical os with which the needle of the Mersilene tape can pass through. The tape was guided from anterior to posterior via a straightened needle. The same was done medial to the left uterine vessels. Afterwards, the tape was placed circumferentially around the internal cervical os of the bicornuate uterus, medial to the uterine vessels and tied posteriorly at the 6 o'clock position. A 2-0 silk was then sutured to the tails of the tape. Both hysteroscopy and cystoscopy were done after the cerclage to ensure no tape or sutures were seen within the cervical canal or the uterine cavity. The success criteria was the ability to attain a viable pregnancy and a live birth after surgery. A spontaneous pregnancy was achieved. A baby weighing 3 pounds and 16 ounces was delivered by cesarean section at 36 weeks due to oligohydramnios. The baby is currently healthy at 13 pounds. Robotic-assisted abdominal cerclage around the internal cervical os in a bicornuate uterus offers a possibly feasible and straightforward technique for surgeons seeking to reduce risks, although further research is needed. [ABSTRACT FROM AUTHOR] |
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