Laparoscopic Sacrocolpopexy: Lessons Learned

摘要

Background: Laparoscopic abdominal sacrocolpopexy is a minimally invasive surgery for vaginal vault prolapse. When performed with equivalent technique, this procedure has similar success rates to the gold standard abdominal sacrocolpopexy performed by laparotomy. This article describes tips for practitioners attempting this complex surgery. Techniques: The recommendations presented in this article include suggestions for equipment in addition to details of the surgical technique. With respect to equipment, we recommend a cylindrical vaginal elevator to facilitate dissection of the vagina cuff, the use of 2 separate pieces of mesh to individualize elevation of the anterior and posterior walls of the vagina, and if the cleared area of the sacrum falls ON the bony promontory, use of a "straight in" bone screw device. In the case of a concurrent hysterectomy, supracervical hysterectomy may decrease the risk of mesh erosion. Full-thickness delayed absorbable sutures on the vaginal cuff are recommended with plication of the mesh as needed to individualize tension of the anterior or posterior vaginal wall. Enterocele repair and retroperitonialization of the mesh can be individualized to each case, but cystoscopy should follow every procedure. Conclusion: The authors think that the surgical techniques described can help maximize the accuracy and safety of this procedure and minimize the steep learning curve usually associated with laparoscopic abdominal sacrocolpopexy.