2059 TSS – Time Sparing Sacrocolpopexy: How to Reduce the Operative Time of Laparoscopic Sacrocolpopexy

Abstract

Video Objective Laparoscopic sacrocolpopexy (LSC) is known to achieve lower recurrence rates, shorter recovery time, and less dyspareunia. However, LSC is problematic because it requires specific laparoscopic skills and the laparoscopy takes longer than other competing operations. In this video, we present the surgical techniques for LSC we are using with a view to shortening operation times and reducing complications. We named this approach Time Sparing Sacrocolpexy (TSS) Design Prospective Clinical Trial Setting San Carlo di Nancy Hospital GVM Care & Research, Rome Patients: Ninety women with symptomatic stage 3 or greater POP underwent LSC in our hospital between November 2016 and January 2019. Interventions Ninety women with symptomatic stage 3 or greater POP underwent LSC in our hospital between November 2016 and January 2019. In the first 80 operations we followed the nerve-preserving technique described by Ercoli et al. in 2017. In the final 10 operations we modified the technique in order to reduce operative time. The main changes were: (1) Use of Bipolar loop to cut the cervix instead of the monopolar hook, (2) make a stitch on the meshes in order to reduce the time of introduction e positioning of them in the pelvis, (3) replacing part of the classic LSC stitches with (i) AbstackT fixations to fix meshes to the anterior and posterior vaginal wall, but maintaining nonabsorbable stitches at the urethrovesical junction, at the cervix, at the level of levator ani muscle and at the sacrum. Measurements and Main Results Operative Time. Intra and post operative related complications. The operation time decreased (around 40%) as the surgical technique improved through experience. No major intra- or postoperative complications occurred. Conclusion These modifications to the technique will help shorten operation times and reduce complications of LSC.