01 Sacrocolpopexy techniques for the savvy surgeon

Abstract

This video demonstrates eight advanced surgical techniques to streamline the laparoscopic sacrocolpopexy (LSCP) procedure. LSCP can be challenging even for the experienced surgeon. Knowledge and adequate visualization of the sacral and pelvic anatomy is paramount to prevent potentially catastrophic intra-operative hemorrhage, nerve, or ureteral injury, and to facilitate presacral dissection. We present several advanced surgical techniques to maximize surgical efficiency, optimize visualization of the sacral anatomy during presacral dissection, as well as a method to facilitate peritoneal closure over the mesh during LSCP. Our surgical tips for LSCP include: (1) Identification of the sacral promontory using anatomic landmarks, (2) Extension of the rectovaginal dissection into the perirectal space prior to mesh placement, (3) Streamlined needle handling, (4) Suture retraction of the sigmoid epiploica, (5) Optimization of the sacral view using the 30-degree scope, (6) Blunt dissection of the presacral space, (7) Purse string peritoneal closure using a monofilament suture with loop, and (8) Maintenance of epiploica suture until reperitonealization complete. We presented eight advanced surgical techniques that are generalizable, maximize surgical efficiency and safety, and can decrease frustration during LSCP.