To present a technique to correct mis-placement of the tape during laparoscopic cervical cerclage. Catching and introducing the wrong needle resulted in a knot formed around the right adnexa.
A step-by-step demonstration of the mistake and technique to correct it.
A Para 0+V patient with cervical insufficiency was managed with laparoscopic interval cerclage [1,2,3]. The patient’s two most recent pregnancies had been managed with emergency transvaginal cerclage, which failed to prolong her gestation beyond 24 weeks.
Prior to the cerclage procedure a 2.0 × 0.8cm deep endometriotic nodule was excised. Both curved needles were straightened extracorporeally, and the tape was dropped inside the peritoneal cavity. The 1 needle was introduced successfully through the right side. After insertion of – what was believed to be – the same needle through the left side following the opposite direction, it was discovered that a tight knot had been formed around the right adnexa (Figure 1). To avoid complete removal, the needles-less tape was pulled back completely from the right side (Supplemental Figure 1), and this end was stitched to a straight needle 2-0 polyglactin suture. The much thinner needle passed easily through the already created path, along with the tape (Supplemental Figure 2), and the procedure was completed as planned (Supplemental Figure 3).
When performing laparoscopic cervical cerclage with the tape and needles inside the abdomen it is important to keep both under constant view. In the event of mis-placement, no need to completely remove the tape. The tape’s cut end can still be re-introduced successfully, stitched to a straight needle suture.
Copyright © 2020. Published by Elsevier Inc.