Laparoscopic Sacrocervicopexy for Uterovaginal Prolapse: Step by Step for Safety and Efficiency

Abstract

<h3>Study Objective</h3> The purpose of this video is to demonstrate the step by step of laparoscopic sacrocervicopexy for uterovaginal prolapse using a Y-shaped monofilament polypropylene mesh. <h3>Design</h3> Laparoscopic Subtotal hysterectomy is performed. After that, opening of the posterior peritoneum took place on the sacral promontory and was extended under the right uterosacral ligament. The Douglas pouch was then opened, and the rectovaginal plane was exposed. This maneuver was facilitated by the introduction and the relevant movements of a vaginal malleable valve. Dissecting the inter vesicovaginal space, the anterior mesh is on the anterior vaginal apex with two other sutures and the anterior mesh was fixed on the anterior vaginal wall just before the trigone and at the isthmus of the uterus. After that, the posterior mesh was fixed on the posterior vaginal apex with two other sutures and on the posterior vaginal wall. Both sutures with a 2/0 polygalactin suture. Mesh were anchored on the sacral promontory using a 0 polypropylene non absorbable suture on the longitudinal ligament. At the end, full peritonization of the mesh with a 2–0 polyglactin running suture. <h3>Setting</h3> Patient positioned in a Trendelenburg lithotomy position with legs slightly bent. A 10-mm trocar was placed at the umbilicus, two 5-mm trocars were positioned 2 cm above and medially to the anterior superior iliac spine and a third was positioned midway between the umbilicus and the pubic symphysis. <h3>Patients or Participants</h3> One 56 years old female patient with uterovaginal prolapse stage IV. <h3>Interventions</h3> laparoscopic sacrocervicopexy for uterovaginal prolapse with Y-shaped monofilament macroporous polypropylene mesh. <h3>Measurements and Main Results</h3> The laparoscopic sacrocervicopexy can be performed in patient at stage IV uterovaginal prolapse after partial hysterectomy in an efficient way. After the laparoscopic sacrocervicopexy surgery, the patient evolved with correction of the prolapse to stage I. <h3>Conclusion</h3> Laparoscopic surgery allows a good view of the vaginal walls performing this procedure safely and efficiently