Design: A stepwise video demonstration of procedure

Setting: Surgery was done using 2D high definition laparoscopy by qualified and experienced team

Patients or Participants: 32 year old patient presented at 23 weeks period of gestation with clinical and ultrasonography finding of short cervix with open internal os with previous history of three second trimester loss with two times failed McDonalds cerclage

Interventions: Laparoscopic emergency cerclage during second trimester pregnancy

Measurements and Main Results:

On USG examination, cervix was short with open internal os. 12 mmHg Pneumoperitoneum was created using direct trochar entry.The procedure involved with following steps- 1) Vesicouterine fold of peritoneum opened and extended laterally till bilateral uterine arteries could be identified. 2) Bladder was pushed down. 3) Avascular spaces in bilateral broad ligaments lateral to uterine vessels was created. 4) 5mm mersilene tape with two curved needles was introduced into the abdominal cavity. 5) One needle was passed through pouch of douglas and was taken out through right avascular space. 6) Left needle was passed from posterior at the level of uterine isthmus and taken out anteriorly medial to uterine vessels. 7) Same procedure was repeated on contralateral side. 8) Tape was knotted with 6-8 knots. Anterior peritoneum was closed. Surgery was uneventful. Pregnancy was continued uneventfully till 39 weeks. A baby weighing 3100 gm was delivered by elective cesarean section.

Conclusion: Laparoscopic emergency abdominal cerclage during second trimester pregnancy is a safe and effective minimal invasive surgery in experienced hands with better obstetric outcome