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Page 4 of 5 Tzabari et al. Mini-invasive Surg 2018;2:9 I http://dx.doi.org/10.20517/2574-1225.2018.11

Table 1. Outcome of cervical dilatation with triple catheter in 15 cases

Case Age, years G (gravity), Cervix diameter
D (delivery) Before dilatation After dilatation
1 33 G1D0 4 9
2 25 G1D0 4 8
3 18 G1D0 4.5 8
4 20 G1D0 2.5 Cervix stenosis
5 19 G1D0 3 7
6 21 G1D0 3.5 8
7 24 G2D0 3 8
8 38 G4D3 3 5.5
9 42 G3D2 4 9
10 32 G1D0 2.5 9.5
11 42 G3D2 4 9
12 27 G1D0 3.5 9
13 37 G4D4 2 4.5
14 29 G6D5 2 5
15 30 G3D2 2.5 5.5

DISCUSSION
Cervical dilatation with Hegar rods is used all-over the world however with the risk of future cervical
incompetence which is higher in nulliparous. During the dilation with Hegar rods, the cervix is stretched
in two different directions, longitudinal and radial, which can be damaging because the cervix consists of
[8]
mainly fibrous tissue and collagen although the percentage of collagen varies with cervical pathologies .
This is in contrast to the body of the uterus where the percentage of the muscular tissue is significantly
[6]
higher than in the cervix . The balloon catheter has the advantage over Hegar rods because it does not
stretch the cervical walls longitudinally, and so minimizing or eliminating the risk of the damage to the
cervical tissue.

Laminaria is associated with lower risk of damage to the cervical wall but the balloon catheter has
advantage over it because desired dilatation can be achieved in several minutes versus hours and two
sittings needed when laminaria is used.

Dilating balloons allowed to successfully dilate the cervix to the desired diameter in all cases except the
diagnosed cervical stenosis and the dilatation was sufficient for all the planned procedures. No vasovagal
attack incidence was recorded during the study.

A novel method to dilate the cervix whenever it is indicated is presented. The balloon catheter proved to be
user-friendly, efficient and is not associated with risks of damage to the cervical wall and potential cervical
incompetence.

This pilot study shows that the balloon catheter is a promising method but more studies will be needed in
order to prove its efficiency and its potential for universal use for any indication of cervical dilatation.

DECLARATIONS
Authors’ contributions
Manuscript preparation and data acquisition: Stark M
Literature search: Stark M
Surgery: Tzabari A
Data acquisition: Tzabari A
Study design and definition of intellectual content: Weichselbaum A