Robotic-Assisted Laparoscopic Abdominal Cerclage Placement During Pregnancy

Gonzales, Soria; Adair, Charles; Torres, Carlos; Rodriguez, Eliezer D.; Mohling, S; Elkattah, Rayan; DePasquale, Stephen

doi:10.1016/j.jmig.2017.12.014

Cited by 12 publications

(10 citation statements)

References 24 publications

(46 reference statements)

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“…Literature on robotic TAC is minimal and consists mostly of case reports and series [22]. Gonzales et al report a case series on robotic TAC in pregnancy (11 patients) with 72.7% of deliveries >34 weeks, similar to our outcome of 78.6% of deliveries >34 weeks [7]. There are a number of comparison studies on conventional laparoscopic TAC to laparotomy with results similar to those of our study [8−12].…”

Section: Discussionsupporting

confidence: 84%

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Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes

Smith¹,

Brink²,

et al. 2020

Journal of Minimally Invasive Gynecology

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To compare obstetric and surgical outcomes of transabdominal cerclage (TAC) via laparotomy (TAC-LAP) versus robotic-assisted (TAC-RA) approaches. Design: Retrospective cohort study. Setting: An academic medical center. Patients: Sixty-nine women with acquired or congenital cervical insufficiency. Interventions: All women underwent TAC either by laparotomy or robotic-assisted approaches by 2 primary surgeons between January 2003 and July 2018. Women with a preconceptional TAC without a subsequent pregnancy were excluded. Measurements and Main Results: A total of 69 women met inclusion criteria in the 15-year study period with 40 in the historical TAC-LAP group and 29 in the TAC-RA group. Gestational age at delivery was similar in the 2 groups (36 weeks 3 days vs 37 weeks; median difference À1 day, 95% confidence interval [CI] À6 to 2, p = .36). There were no differences in birth weight, Apgar scores, neonatal intensive care unit admission, or neonatal survival. Estimated blood loss and length of stay were significantly greater in the TAC-LAP group (50 mL vs 20 mL; median difference 25, 95% CI 5−40, p = .007 and 76 hours vs 3 hours; median difference 71, 95% CI 65−75, p <.001, respectively). Operative time was significantly shorter in the TAC-LAP group (65 minutes vs 132 minutes; median difference À64.7, 95% CI À79 to À49, p <.001). There was one intra-operative complication and 4 minor postoperative complications in the TAC-LAP group and none observed in the TAC-RA group. All outcomes were similar when comparing postconceptional TAC alone, except there was no longer a difference in blood loss. When comparing pre-versus postconceptional robotic TAC, there were no differences in surgical outcomes. Conclusion: Robotic TAC has similar favorable obstetric outcomes to traditional laparotomy and is associated with reduced blood loss and shorter hospital stays. Despite longer operative times, the robotic group did not experience any intra-operative or postoperative complications, which speaks to the benefits of this minimally invasive approach to TAC.

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Section: Discussionsupporting

confidence: 84%

“…The robotic-assisted approach to TAC is gaining popularity for reasons related to improved visualization afforded by the 3-dimensional optics and ease of fine dissection and knot tying afforded by the endowristed instruments [7]. Comparison studies exist for conventional laparoscopic TAC vs traditional laparotomy approaches [5,8−13].…”

mentioning

confidence: 99%

Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes

Smith¹,

Brink²,

et al. 2020

Journal of Minimally Invasive Gynecology

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“…The systematic search in PubMed and in Scopus databases revealed a total of 42 and 123 search results, respectively, among which 14 studies (four case series and 10 case reports) were identified as eligible for inclusion in this review, according to the inclusion criteria. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] One additional study was identified through the search of references of the included studies. 25 The selected studies for inclusion were presented in details in Figure 1…”

Section: Resultsmentioning

confidence: 99%

“…Perioperative fetal loss is described in four out of 30 cases. The reasons of fetal losses were cardiorespiratory failure and premature rupture of membranes …”

Section: Discussionmentioning

confidence: 99%

“…The reasons of fetal losses were cardiorespiratory failure and premature rupture of membranes. 19,24 The 13 Menderes et al proposed a large prospective cohort study in patients who are candidates for abdominal cerclage placement to further understand the safety and efficacy of this technique, as it has potential to improve fetal outcomes while decreasing surgical morbidity, as well as the potential to be more commonly employed by laparoscopic surgeons. 13 Furthermore, Kim et al questioned which is the best timing of the procedure, a parameter for which no clear answer is given in the current literature due to limited data.…”

Section: Discussionmentioning

confidence: 99%

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Robotic assisted laparoscopic cerclage: A systematic review

Iavazzo

Minis

Gkegkes

2018

Robotics Computer Surgery

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Introduction The gold standard in the management of cervical incompetence is cerclage via vaginal approach. Minimally invasive techniques, such as robotic, have been also described. Materials and Methods A systematic search was performed in PubMed and Scopus, searching evidence on robotic assisted laparoscopic cerclage in both pregnant and non pregnant women. Results Sixty‐four patients were included in this study. Cervical insufficiency, failure of transvaginal cerclage, and short cervix were the most frequent indications for robotic assisted cerclage. Mean operative time was 107.3 minutes. Mean estimated blood loss was 62.8 mL. Four patients converted to laparotomy. No postoperative complications were reported. Pregnancy after robotic cerclage was reported in 59 patients with mean gestational age at delivery of 36.4 weeks. The majority of pregnant women who underwent robotic assisted cerclage gave birth to live neonates. Conclusion Till now, evidence does not show a clear advantage of robotic over laparoscopic approach, under the evaluation of the current literature. However, further comparative studies might be essential to clarify the possible role of da Vinci robot in this field; this might be quite difficult even in the near future based on the fact that only five cases per year are described in the current literature.

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The effectiveness of transabdominal cerclage placement via laparoscopy or laparotomy: a systematic review and meta-analysis

Hulshoff¹,

Hofstede²,

IntHout³

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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Robotic-Assisted Laparoscopic Abdominal Cerclage Placement During Pregnancy

Abstract: RALAC is a minimally invasive procedure with an acceptable risk profile and comparable efficacy to traditional open abdominal cerclage. RALAC may be considered an acceptable alternative to open abdominal cerclage in pregnancy, and may be a particularly favorable option in certain settings.

Cited by 12 publications

References 24 publications

Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes

Robotic Transabdominal Cerclage vs Laparotomy: A Comparison of Obstetric and Surgical Outcomes

Robotic assisted laparoscopic cerclage: A systematic review

The effectiveness of transabdominal cerclage placement via laparoscopy or laparotomy: a systematic review and meta-analysis

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