Abstract
the end of the case. We dissect the peritoneum over the sacral promontory to expose the anterior longitudinal ligament. The rectovaginal space is developed and the bladder is dissected off the vagina. The Y-shaped polypropylene mesh is prepared by rolling and suturing the sacral extension to keep it out of the way during vaginal suturing and placing a hole in the posterior arm of the mesh to fit over the transcervical cannula. It is inserted through the transcervical cannula and secured to the anterior and posterior vaginal wall with permanent sutures, using extracorporeal knot tying. Needles are introduced and removed through the transcervical cannula. We then suture the sacral extension to the anterior longitudinal ligament. A barbed delayed absorbable suture is then used to close the peritoneum, and the 0-Vicryl suture that was placed transvaginally as a cerclage is tied down when the transcervical cannula is removed. Conclusion: We describe our streamlined laparoscopic approach using 5 mm skin incisions and transcervical morcellation for advanced uterine prolapse. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS:
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