Laparoscopic transfundal approach to cervical dilation: a novel treatment for cervical stenosis and cervical factor infertility

Abstract

Objective: To demonstrate a novel technique used to restore cervical patency in a patient with severe iatrogenic cervical stenosis.

Design: Surgical video case report.

Setting: A single academic institution.

Patient(s): We highlight the case of a 35-year-old nulliparous woman with a history of primary infertility. Her past medical history was significant for focal, invasive, well-differentiated squamous cell carcinoma of the cervix, for which she underwent a loop electrosurgical excision procedure. During her infertility assessment, she was found to have an extremely stenotic cervix that was refractory to conventional treatment options.

Interventions: This video highlights our innovative laparoscopic transfundal technique used to restore her cervical patency.

Main outcome measures: None, as this is a descriptive case report.

Results: Postoperatively, the patient had continued cervical patency for >1 year with successful fertility treatment resulting in pregnancy.

Conclusions: To our knowledge, this is the first case report describing a laparoscopic transfundal approach used to reestablish cervical patency. This approach may be considered for patients with cervical stenosis who have not responded to standard conservative therapies.

Keywords: Reproductive surgery; cervical factor infertility; cervical stenosis; operative laparoscopy.