Transvaginal Single-Port Laparoscopy Pelvic Reconstruction with Y-Shaped Mesh

Abstract

Study objective: To demonstrate a new technique for pelvic reconstruction in patients with multiple-compartment pelvic organ prolapse (POP) using Y-shaped mesh via transvaginal single-port laparoscopy.

Design: Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III).

Setting: It is more and more prudent for pelvic floor reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of pelvic reconstruction via natural orifice transluminal endoscopic surgery is feasible.

Interventions: The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm "window" of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the pelvic peritoneum was closed, a "window" of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up.

Conclusion: Transvaginal single-port laparoscopic pelvic reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.

Keywords: Pelvic organ prolapse; Pelvic reconstruction; Single-port laparoscopy; Transvaginal; Y-shaped mesh.