Abstract
Introduction
Pelvic organ prolapse is an ordinary disease with around 200.000 surgeries performed annually in the US to treat this condition. The surgical treatment for complete vaginal vault prolapse after hysterectomy involves abdominal or vaginal sacrocolpopexy. The purpose of this video is to demonstrate the steps of a laparoendoscopic single-site surgery (LESS) sacrocolpopexy performed by a simplified knotless technique.
Materials and Methods
A 52 year-old female submitted a total hysterectomy five years ago due to miomatosis who developed vault prolapse and urinary incontinence after surgery. She was treated by transumbilical LESS cutaneous retractor and a surgical glove attached to three trocars through a 3.5 cm umbilical incision. Patient was positioned in lithotomy, the Y-shape polypropylene mesh was passed through the trocar. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix using 3 continuous sutures held in extremities by polymeric clips. The last helical suture was fixed by polymeric clips to the sacral periosteum from the promontory to achieve good vaginal positioning without tension. The posterior peritoneum was closed over the mesh.
Results
The operative time was 150 minutes, blood loss of approximately 100 mL and the patient was discharged after 18 hours with no immediate complications and a 3 months follow-up free of vault prolapse and urinary incontinence until now.
Conclusions
LESS sacrocolpopexy performed with conventional instruments is feasible and a safe procedure reproducing surgical steps of conventional laparoscopic or robotic surgery.
ARTICLE INFO
Available at: www.brazjurol.com.br/videos/november_december_2012/Tobias-Machado_859_860video.htm
Int Braz J Urol. 2012; 38 (Video #7): 859-60
Editorial comment
Authorship SCIMAGO INSTITUTIONS RANKINGSThe authors from the Department of Urology, ABC Medical School report on a case of a 52 year old female who developed vault prolapse and urinary incontinence subsequently after undergoing Total Hysterectomy. Her pathology was formally diagnosed with Pelvic Organ Prolapse Quantification (POP-Q) stage 3. The authors then highlight the steps involved in performing a Transumbilical LESS sacrocolpopexy. There are good graphic representations of the steps involved in this repair. Mesh and suture material were accurately described. Specific surgical parameters of the case were also disclosed (surgery time, estimated blood loss). Finally, post-operative report was given in support of this procedure. Limitations were acknowledged with this relatively new technique.
Publication Dates
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Publication in this collection
Nov-Dec 2012
History
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Received
12 Sept 2012 -
Accepted
28 Oct 2012
