Laparoscopic Sacrocervicopexy

laparoscopic sacrocervicopexy

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.

Indication

  • Uterine prolapse.

Technique

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).

Preparation of the promontory fixation site. Distance yourself from sigma, big vessels, ureter and nerves. Remain on the surface.
Fixing the mesh with an absorbable tack fixation device. Alternatively non-absorbable material can be used.
Fixation of the mesh on the cervix.

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.
Fixation of the mesh on the promontory. We use two non-absorbable sutures.

Contraindications

  • Gynecological malignancy or suspicious cytology from the cervix.
  • Patient desires future pregnancy.
  • Laparoscopy is contraindicated.

Complications

  • Big vessel injury and bleeding.
  • Injury of the right ureter, the sigmoid colon, or the bladder.
  • Lumbar spondylodiscitis.
  • De novo stress urinary incontinence.

Postoperative Management

  • 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.

Bibliography

  • 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 Surgeons17(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. Medicine98(49), e18252. https://doi.org/10.1097/MD.0000000000018252

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