Cervico-Isthmic Cerclage and Cystoscopy Surgery

In the following video, Heidi Wittenberg and Michael Katz give a step by step commentary of a Cervico-Isthmic Cerlage and Cystoscopy, while in San Francisco, California. If you have questions about this procedure or think that you may be a candidate.

Dr Michael Katz, a high risk obstetrical specialist, is an expert in cerclages. In collaboration with urogynecologist Heidi Wittenberg, difficult and repeat cerclages are performed. We are tracking over 115 cerclages performed with this particular approach with very few deliveries prior to 39 weeks. One delivery was at 35 weeks in a patient that was 40 advanced maternal age, ivf and diagnosed with pre-eclampsia who had to be induced. Another had an abruption 6 weeks after cerclage placement at 18 weeks.

We propose that this cerclage placement is in the same place as an abdominal cerclage without requiring abdominal access. This means this procedure is done via minimally invasive vaginal approach, performed under regional, not general anesthesia, can be removed in same fashion. Doesn’t require cesarean section, patients can deliver vaginally if there are no contraindications. And we believe results are comparable to abdominal cerclage.

Candidates for Cerclage

Candidates for this procedure include any patient who has had any of the following procedures to thier cervix in the past:

  • LEEP
  • Cone
  • Trachelectomy
  • Prior Urologic Injury/Repair
  • Prior Cerclage

Cervico-Isthmic Cerlage Step by Step

  • Access
  • Placement of Cerclage at Cervico-Isthmic Border
  • Cystoscopy
  • Encircle Cervix
  • Second Cystoscopy
  • Closing