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Robotic Cerclages: A Case Series Analyzing Costs at a Single Institution [168]

INTRODUCTION: Cervical insufficiency is defined as painless cervical dilation and pregnancy loss in the second trimester, typically before 24 weeks of gestation. Its incidence is 0.1–1% of all pregnancies and 8% of second-trimester losses. Treatment includes nonsurgical and surgical approaches. Occasionally, after failed vaginal cerclages or in patients who have amputated or congenitally abnormal cervices, transabdominal cerclage is utilized. Recent advances in technology have allowed for the use of the DaVinci robot to perform transabdominal cerclages laparoscopically. CASE PRESENTATION: This case series presents three cases of robotically placed cerclages. All three patients had extensive histories of second-trimester losses and previous failed vaginal cerclages. The patients were discharged home on the day of surgery with minimal intraoperative blood loss and postoperative pain. In two patients, pregnancies progressed to term and delivered without complication by cesarean. The third patient has not become pregnant yet. At our institution, the total hospital costs for the three robotic cerclages averaged approximately $1,000 more than the traditional approach. DISCUSSION: Compared with the open approach, the robotically assisted laparoscopic approach allows for significantly decreased morbidity for the mother and possibly the fetus. The difference in cost can be attributed to additional procedures performed during the robotic surgery. Robotically placed cerclages can also be performed before conception, also decreasing the risk to the fetus. CONCLUSION: These cases suggest robotically placed cerclages is a viable and less invasive alternative to traditional transabdominal cerclages but may be more expensive.