A New Laparoscopic Meshless Sacrocervicopexy for Central Compartment Prolapse: Bologna Sacrocervicopexy

Abstract

Introduction: The uterovaginal prolapse (UVP) is one of the most frequent surgical indications in gynecology.1 The lifetime probability for a woman to undergo UVP surgery is 11%2 and this percentage is expected to increase as the population is gradually aging. The goal of pelvic organ prolapse surgery is to restore the support and suspension of the pelvic organs to improve bladder, bowel, and sexual function. According to the Cochrane review, for the correction of the UVP, abdominal promontofixation represents the gold standard surgical procedure, because this procedure is associated with a lower rate of recurrent prolapse and less dyspareunia.3 Despite the excellent results confirmed by several studies, the laparoscopic promontofixation approach is not widely used because of the long learning curve required and risks associated with the mesh use, especially infection, erosion, and dyspareunia.4,5 In this video article, we explain our new technique of laparoscopic meshless cervicosacropexy in women without pregnancy desire. Interventions: Before the laparoscopy if necessary, the anterior and posterior prolapse were treated by standard vaginal approach. A standard four-puncture laparoscopy was performed. A supracervical hysterectomy was performed by the conventional technique. Bologna meshless sacrocervicopexy consists in suspension of the cervix to the anterior longitudinal ligament of sacral promontory through a continuous suture (monofilament and nonabsorbable thread—Prolene™) plicating and shortening the right uterosacral ligament. The surgical steps are as follows: (1) The presacral space is developed and a first stitch hitching the longitudinal ligament of sacral promontory is placed, after the identification of medial sacral vessels and left iliac vein, avoiding vascular injury. (2) The continuous suture plicates the right uterosacral ligament and identifies the right ureter. (3) The needle pierces the torus uterinum and the endopelvic fascia is restored. (4) The suture comes back to the sacrum along the right uterosacral ligament. (5) The suture is tied, making sure to be tension free. (6) The peritoneum covering the sacral promontory was closed. Results: In our case series of 32 women treated by this new technique, mean operative time was 45 ± 12.4 minutes (range 30–74), mean hospitalization stay was 4.6 ± 0.9 days (range 2–6), and mean hemoglobin level decrease was 2.2 g/dL ± 0.8 g/dL (range 0.4–4.2). No perioperative complications were observed. Conclusion: Despite further studies with a larger number of patients are needed, Bologna sacrocervicopexy seems to be a feasible and easy option for treating central prolapse in sexually active women without pregnancy desire. This meshless procedure could obviate the risks caused by mesh placement and represents a simple and feasible technique. The use of monofilament nonabsorbable suture might be useful to the integrity and the endurance of our repair. However, long-term success rate should be evaluated in larger studies. No competing financial interests exist. Runtime of video: 7 mins 23 secs