1201 Laparoscoic Supracervical Hysterectomy and Sacrocervicopexy Using Flexdex's Platform Technology with Extraction of The Surgical Specimen by the Posterior Colpotomy for the Treatment of Uterine Prolapse

Abstract

Video Objective Demonstrate the functionality and capabilities of the FlexDex platform in a high technical complexity procedure, a videolaproscopy supracervical hysterectomy with cervicosacropexy. Setting A 76-years-old patient with uterine prolapse (POP-Q stage III) was selected for laparoscopic treatment with the aid of the FlexDex platform. Interventions Initially, the supracervical hysterectomy was performed, followed by the cervix closure and the opening of the peritoneum at the level of the promontory – identifying the hypogastric nerve, lateralizing it with the endopelvic fascia and medializing the mesosigmoid fascia for the development of the pararectal space. Thus, allowing continuity to rectovaginal space and preparing the mesh bed. Next, a lightweight, macroporous, Y-shaped polypropylene mesh was fixated to the cervix stump – being assisted by the FlexDex platform, which enables the suturing to be made backhanded in a angulated topography. Then, the anatomical landmarks were identified before proceeding to the sacropexy - middle sacral vessels, sacral promontory, anterior longitudinal ligament, aortic bifurcation, inferior vena cava, right common iliac vessels and right ureter. After the mesh fixation to the promontory, the burial of the mesh was achieved with the closure of the peritoneum with a continuous suture. All the suturing during the surgery was accomplished utilizing only one trocar arrangement, enabled by the virtual center of rotation of the FlexDex platform. The surgical specimen was removed by posterior colpotomy, avoiding its morcellation. Once again, the closure of the posterior vaginal wall was facilitated by the endless rotation of the platform, enabling the ideal movement of the needle, following its curvature. Conclusion The FlexDex platform allows similar amplitude and intuitive wrist movement of the surgeon during complex procedures such as the one here presented – being a cost-effective alternative to the robot technology in countries where it is not readily available.