Laparoscopic Nerve-Sparing Sacropexy: Tips and Tricks for a Safe and Anatomical Surgical Procedure

Abstract

Study Objective to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. Design A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Setting Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients or Participants Patients with POP-Q Stage III and IV/prolapse of uterine Interventions Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. Measurements and Main Results LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. Conclusion A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps. to demonstrate a nerve-sparing technique during laparoscopic sacropexy (LSP) for treatment of multicompartment pelvic organ prolapse. A step-by-step demonstration of our surgical procedure of laparoscopic sacropexy (LSP). Sacropexy is the 'gold standard' procedure for apical prolapse. This procedure is characterized by a complete dissection of the avascular spaces and is nerve sparing technique saving superior and inferior hypogastric plexus and the hypogastric nerves. Patients with POP-Q Stage III and IV/prolapse of uterine Our surgical nerve-sparing LSP technique proceeds in 10 steps: Step 1: Suspension of the sigma to the abdominal wall. Step 2: Opening the peritoneum and exposure of sacral promontory and of the longitudinal anterior vertebral ligament. Step 3: Dissection of the right medial pararectal space (Okabayashi's Space), respecting the integrity of the presacral fascia and of the rHN contained within it. Step 4: Dissection of the rectovaginal space with a latero-medial approach expecting the integrity of the rectal fascia. The lateral limits were defined by the uterosacral and rectovaginal ligaments, and the base was represented by the perineal body and levator ani muscle. Step 5: Dissection of the vesicovaginal space through the creation of an avascular space with the apex at the dorsal end of the bladder trigone and laterally limited by the vesicouterine ligaments. Step 6: Subtotal hysterectomy. Step 7: A first synthetic mesh (posterior) fixed with a total of five no. 3–0 non-absorbable sutures. Step 8: A second synthetic mesh (anterior) fixed with five no. 3–0 non-absorbable sutures. Step 9: Mesh fixation on the cervical stump and ligamentum longitudinale. Step 10: Mesh peritonealization. LSP combines the high efficacy of reconstructive surgery using non-absorbable mesh with the fast recovery and low complication rate resulting from minimal tissue trauma and laparoscopicalprocedure precision. A nerve-sparing approach to pelvic spaces during LSP is feasible following well-defined surgical steps.