Laparoscopic Sacrocolpopexy is performed to treat women with pelvic organ prolapse. The aim of the operation is to restore normal pelvic anatomy by elevating and fixating the apex of the vagina. Fixation can be strengthened with the use of meshes affixed to the sacral promontory.
In detail, the indications are for women with vaginal vault prolapse, or vaginal cuff prolapse after hysterectomy. If a patient also suffers from anterior and / or posterior vaginal wall prolapse, they may be concomitantly treated. Laparoscopic surgery techniques ensure a minimally invasive intervention, with a quick recovery time and return to normal activities.
- The surgical steps are as follows:
- Placement of patient in low lithotomy position
- Placement of trocars (4-5 trocars, 2x10mm, 2-3x5mm)
- Placement of malleable retractor in vagina for retraction and exposure
- Dissection of Sacral promontory
- Dissection of vaginal and surrounding tisues
- Attachment of mesh to vaginal apex, anterior and posterior surfaces of vagina
- Elevation of vaginal apex with mesh and attachment of mesh to sacral promontory using sutures or bone anchoring devices
Laparoscopic sacrocolpopexy has similar cure rates as open abdominal sacrocolpopexy, but offers better results in hospital stay days, abdominal complications, bleeding and post-operative pain. Because the length of the vagina is preserved, dyspareunia is less frequent compared to Transvaginal prolapse repairs. Also, mesh erosion is rarer as compared to the Transvaginal approach.
Overview of pelvic anatomy with malleable retractor in vagina and bladder catheter
Dissection of Sacral Promontory
Dissection proceeds until the periosteum
Dissection of posterior surface of vagina
Dissection of Anterior surface of vagina
Attachment of Y-shaped mesh to posterior vaginal surface
Attachment of mesh to anterior vaginal surface
Elevation of vaginal apex
Anchoring of mesh to promontory
Peritoneum sutured over mesh to prevent intestinal adhesion to mesh