Dr. Peter KrugerUrogynecology & Surgery
Minimally Invasive Surgery

Laparoscopic Cerclage

Minimally invasive placement of a cervical cerclage for cervical insufficiency and recurrent pregnancy loss, typically performed prior to or in early pregnancy.

Overview

Laparoscopic cerclage — suture tape placed around the cervix at the internal os

Laparoscopic cerclage is a minimally invasive procedure in which a suture or tape is placed around the cervix at the level of the internal os to provide structural support and prevent premature cervical dilation. It is typically performed in women with cervical insufficiency — a condition in which the cervix shortens and dilates prematurely, leading to recurrent second-trimester pregnancy loss or preterm delivery.

Indications

  • Failed transvaginal cerclage: Previous vaginal cerclage that did not prevent pregnancy loss
  • Short or surgically altered cervix: Including prior trachelectomy, cone biopsy (LEEP/LLETZ), or cervical trauma
  • Cervical insufficiency: Documented history of painless cervical dilation and recurrent mid-trimester loss
  • Anatomically difficult cervix: Cases where a vaginal approach is technically unfeasible

Timing

  • Pre-pregnancy (interval) placement: Ideally performed before conception, which allows for optimal surgical visualization and suture positioning
  • Early pregnancy placement: Can be performed in the first trimester (typically 10–14 weeks) when clinically indicated
  • The cerclage remains in place for all future pregnancies and delivery is by planned cesarean section

Surgical Technique

  • Performed under general anesthesia using laparoscopic instruments
  • 3–4 small abdominal incisions (5–12 mm)
  • A permanent suture or polyester tape is placed around the cervix at the cervicoisthmic junction, posterior to the uterine vessels
  • Operative time is typically 45–90 minutes
  • Usually performed as a day surgery procedure

What to Expect After Surgery

  • Most patients go home the same day
  • Mild pelvic discomfort for a few days, managed with simple analgesia
  • Return to normal activities within 1–2 weeks
  • Regular follow-up with your obstetrician during subsequent pregnancies
  • Delivery by planned cesarean section (the cerclage is left in place permanently)

Advantages Over Transvaginal Cerclage

  • Higher placement at the internal os level, providing more effective mechanical support
  • Particularly beneficial when there is limited vaginal cervical length
  • Associated with excellent pregnancy outcomes in the published literature
  • One-time placement that remains effective for future pregnancies

Risks and Success Rates

Laparoscopic cerclage has a high success rate for maintaining pregnancy in appropriately selected patients with cervical insufficiency. Potential risks include:

  • Bleeding at the time of surgery
  • Infection — uterine or wound infection
  • Preterm premature rupture of membranes
  • Preterm labour — despite the cerclage
  • Injury to surrounding structures — uncommon
  • Need for cesarean delivery — the cerclage is typically left in place permanently, and delivery is by planned cesarean section