Microlaparoscopy in Urogynecology: LSH and Sacrocervicopexy

Abstract

Study ObjectiveTo determine the feasibility of using only microlaparoscopic (3.5 mm) accessory instruments for performing laparoscopic supracervical hysterectomy (LSH) and sacrocervicopexy with the aid of a transcervically placed cannula for introduction of mesh and needles. DesignRetrospective evaluation of the first five cases of microlaparoscopic LSH with sacrocervicopexy (Canadian Task Force classification III). SettingCommunity teaching hospital affiliated with a major teaching hospital. PatientsFive women with symptomatic uterovaginal prolapse of stage II or higher. InterventionsLSH with transcervical morcellation followed by sacrocervicopexy with all 3.5 mm instruments using synthetic mesh with anterior and posterior extensions. Measurements and Main ResultsFour ports were made in all patients: a 5-mm infraumbilical port for the laparoscope and three 3.5-mm ports (right and left paraumbilical and suprapubic). LSH was performed using a 3-mm bipolar grasping device and reusable monopolar scissors. Resection of the uterus was also performed using monopolar scissors. Transcervical coring through the vagina was performed using a 15-mm serrated cylindrical blade with a central rod placed upward through the cervix, and transcervical morcellation was performed using an electromechanical morcellator. In all patients, sacrocervicopexy was performed successfully using Y-shaped polypropylene mesh, with PTFE sutures on the vagina and the sacral promontory. Reperitonealization over the mesh was performed using a running barbed absorbable suture. There were no intraoperative or postoperative complications in this group of patients. ConclusionLSH and sacrocervicopexy using 3.5-mm accessory ports is a feasible procedure with the use of transcervical morcellation and a transcervical access cannula.