Transvaginal Single-Port Laparoscopy Sacrocolpopexy

Abstract

Study objective: More and more patients are pursuing minimally invasive surgery, which is becoming the trend for gynecologic surgery today. Pelvic organ prolapse (POP) is no exception. With the application of natural orifice transluminal endoscopic surgery, minimally invasive transvaginal sacrocolpopexy surgery assisted by single-port laparoendoscopy for POP becomes feasible. Here we describe our technique of transvaginal sacrocolpopexy using single-port laparoscopy for middle compartment POP.

Design: Step-by-step explanation of the procedure using video.

Setting: University hospital.

Patient: A 59-year-old woman from China.

Interventions: Transvaginal single-port laparoscopy sacrocolpopexy.

Measurements and main results: We performed transvaginal single-port laparoscopy sacrocolpopexy on a 59-year-old woman from China who was diagnosed with POP-Q stage II anterior compartment, stage III middle compartment, stage II posterior compartment. This patient complained of a vaginal mass that had been prolapsed for 3 months. Institutional Review Board/Ethics Committee approval was obtained. Vaginal hysterectomy was performed first. Preventative bilateral salpingo-oophorectomy was done after a single-port platform was established. Right pelvic peritoneum was incised, from the promontory to the vault. Then, we exposed the rectovaginal and vesicovaginal spaces after injection of a water cushion (normal saline, 0.9% Nacl). A Y-shaped mesh (ARTISYN; Johnson & Johnson international, c/o European Logistics Centre, Diegem, Belgium) was fixed to the posterior vaginal wall and then to the sacral promontory (S1). After closing the pelvic peritoneum the anterior mesh was sutured. Before finishing the surgery we closed the vaginal cuff. The operation last for about 2 hours, with a blood loss of 50 mL. The patient was discharged with complete recovery. A 5-month follow-up showed no prolapse, mesh erosion, or other complications.

Conclusion: Transvaginal single-port laparoscopic sacrocolpopexy is a considerable choice for middle compartment POP. However, more cases should be enrolled, and additional studies are required.

Keywords: POP; Sacral colpopexy; Single-port laparoscopy; Transvaginal.