gms | German Medical Science

Introduction: Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Isolated anterior compartment failure can occur especially if paravaginal defect has initially been present. According to our and other results anterior recurrence can occur in up to 10% of cases and additional surgery is needed in about 5-6%. In the last 2 years we adapted our technique of lateral fixation of the anterior mesh during laparoscopic sacrocolpopexy to reduce the risk of anterior recurrences and the first results are very encouraging.

Methods: The video demonstrates the cases of a 67 years old patient undergoing laparoscopic sacrocolpopexy because of combined prolapse. After accomplishing supracervical hysterectomy and posterior dissection, the anterior dissection is started by opening the vesico-vaginal space and separating the bladder from the vagina till the level of the bladder trigone. Lateral dissection is performed by opening the paravaginal space and exposing the lateral edge of the vagina. The distal part of the ureters is dissected from the anterior parametrium to the bladder to avoid ureteral damage. The anterior mesh is than sutured to the distal vaginal in the midline and laterally to the edge of the vagina. Posterior mesh is sutured on the levator ani muscle and the cervix. Both meshes are fixed at the longitudinal ligament of the promontory to guarantee a tension free suspension. At the end a fully peritonealization is performed.

Results: Perioperative results of laparoscopic sacrocolpopexy with deep and lateral mesh fixation are excellent. As we are following all our patients after laparoscopic sacrocolpopexy we can report on a significant improvement of anatomical outcome in the anterior compartment at least in the short term follow up.

Conclusion: Lateral dissection and mesh fixation in the anterior compartment during laparoscopic sacrocolpopexy seem to be feasible and safe and could help to significantly reduce the risk of anterior recurrences. Prospective anatomical evaluation must be performed to scientifically verify these promising initial results. This video demonstrates the surgical technique which has become standard in our institution.