The Stark (Misgav Ladach) Cesarean Delivery A Streamlined Surgical Technique: Development, Rationale and Clinical Outcomes.

Abstract

BACKGROUND Cesarean delivery (CD) rates have risen globally, yet many steps of the procedure remain unstandardized. Wide variation in abdominal and uterine incisions, peritoneal handling, and closure techniques hinders meaningful comparisons of outcomes. To improve outcomes and facilitate comparison among surgeons and hospitals, a standardized surgical approach was developed at the Misgav Ladach Hospital through an iterative, critical evaluation of each operative step. Guided by minimally invasive surgical principles, the method favors gentle separation along natural anatomical planes, reducing trauma and the need for dissection. Only essential steps were retained and optimized, resulting in what is now termed the Stark (Misgav Ladach) Cesarean technique. Over 30 years of implementation, both in low- and high-resource settings, has demonstrated superior outcomes compared with conventional methods. These include shorter skin-to-delivery time, reduction in blood loss and febrile morbidity, fewer adhesions and decreased need for analgesics. OBJECTIVE This article aims to describe the surgical steps and rationale of the Stark (Misgav Ladach) Cesarean Delivery as a guideline suggestion for the global implementation of this method and as a model for standardization for other surgical procedures.