We present a technique for laparoscopic sacrocervicopexy for treating apical prolapse using three trocars. Concomitant colporrhaphy should be performed at the beginning of the surgery if anterior or posterior prolapse coexist.
- Uterine prolapse.
If colporrhaphy is needed, begin with the colporrhaphy.
The laparoscopy begins with the placement of a 10mm umbilical and two accessory 5mm ports on the left (surgeon’s) side. The first of them is placed 3cm lateral of the umbilicus and the second one 2cm medial of the anterior superior iliac spine (ASIS).
The mesh is now passed through the retroperitoneal tunnel. The second assistant elevates the cervix as high as possible, then retracts the cervix 2-3cm.This motion dictates the correct length of mesh to fixate on the promontory.
- Gynecological malignancy or suspicious cytology from the cervix.
- Patient desires future pregnancy.
- Laparoscopy is contraindicated.
- Big vessel injury and bleeding.
- Injury of the right ureter, the sigmoid colon, or the bladder.
- Lumbar spondylodiscitis.
- De novo stress urinary incontinence.
- Removal of transurethral urinary catheter (duration maximum 24 hours unless concomitant colporrhaphy was performed).
- Removal of vaginal packing if concomitant colporrhaphy was performed.
- Low-Molecular-Weight-Heparin (LMWH) once daily.
- Control residual bladder volume, perform nephrosonography and inspect the wound before discharge.
- Postoperative restrictions for 6 weeks.
- Follow-up in 6-8 weeks.
- Rosati, M., Bramante, S., Bracale, U., Pignata, G., & Azioni, G. (2013). Efficacy of laparoscopic sacrocervicopexy for apical support of pelvic organ prolapse. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 17(2), 235–244. https://doi.org/10.4293/108680813X13654754535115
- Qu, D. C., Chen, H. B., Yang, M. M., & Zhou, H. G. (2019). Management of lumbar spondylodiscitis developing after laparoscopic sacrohysteropexy with a mesh: A case report and review of the literature. Medicine, 98(49), e18252. https://doi.org/10.1097/MD.0000000000018252