Laparoscopic Pectopexy

  • Artur Palmas Serviço de Urologia, Hospital das Forças Armadas, Lisboa; CUF Urology Department, Hospital CUF Cascais, Cascais
  • Nuno Domingues Serviço de Urologia, Hospital das Forças Armadas, Lisboa; CUF Urology Department, Hospital CUF Cascais, Cascais
  • Carlos Santos Serviço de Urologia, Hospital das Forças Armadas, Lisboa
  • Macieira Pires Serviço de Urologia, Hospital das Forças Armadas, Lisboa; CUF Urology Department, Hospital CUF Cascais, Cascais
Keywords: Laparoscopy/methods, Ligaments/surgery, Pelvic Organ Prolapse/surgery, Prostheses and Implants

Abstract

Different operative approaches for the repair of a genital prolapse have been reported. However, for the reconstitution of a physiological axis of the vagina, a sacropexy seems to be the most adequate approach. We describe a method of laparoscopic apical prolapse surgery, where the lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. The iliopectineal ligament is a stable structure for the fixation of meshes and sutures, statistically significant stronger than the sacrospinous ligament and arcus tendinous of pelvic fascia. The incidence of defecation disorders, are reduced by a more physiological lateral fixation, which does not reduce the pelvic space. We used a single-port transumbilical device, with an additional 5 mm port, where at the end of the procedure, the drain is placed. This technique, a virtually scarless surgery, represents also, an option for women, who have an esthetic concern about scars.

Downloads

Download data is not yet available.

References

1. Beer M, Kuhn A. Surgical techniques for vault prolapse: A review of the literature. Eur J Obstet Gynecol Reprod Biol. 2005; 119: 144-55.
2. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Abdominal sacrocolpopexy: A comprehensive review. Obstet Gynecol. 2004; 104: 805-23.
3. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010:CD004014.
4. Sullivan ES, Lonaker CJ, Lee PY. Total pelvic mesh repair: A ten-year experience. Dis Colon Rectum. 2001; 44: 875-63.
5. Culligan PJ, Murphy M, Blackwell L, Hammons G, Graham C, Heit MH. Long-term success of abdominal sacral colpopexy using synthetic mesh. Am J Obstet Gynecol. 2002; 187: 1473-82.
6. Baessler K, Schuessler B. Abdominal sacrocolpopexy and anatomy and function of the posterior compartment. Obstet Gynecol. 2001; 97: 678-84.
7. Nieminen K, Heinonen PK. Long-term outcome of abdominal sacral colpopexy or vaginal sacrospinous ligament fixation for posthysterectomy vaginal vault prolapse. J Pelvic Surg. 2000; 5: 254-60.
8. Shiozawa T, Huebner M, Hirt B, Wallwiener D, Reisenauer C. Nerve-preserving sacrocolpopexy: Anatomical study and surgical approach. Eur J Obstet Gynecol Reprod Biol. 2010; 152: 103-7.
9. Irvine L, Shaw R. The effects of patient obesity in gynaecological practice. Curr Opin Obstet Gynecol. 2003; 13: 179-84.
10. Banerjee C, Noé KG. Laparoscopic pectopexy: A new technique of prolapse surgery for obese patients. Arch Gynecol Obstet. 2011; 284: 631-5.
11. Cosson M, Boukerrou M, Lacaze S, Lambaudie E, Fasel J, Mesdagh H, et al. A study of pelvic ligament strength. Eur J Obstet Gynecol Reprod Biol. 2003; 109: 80-7.
12. Noé K, Schiermeier S, Alkatout I, Anapolski M. Laparoscopic pectopexy: A prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy–
postoperative results and intermediate-term follow up in a pilot study. J Endourol. 2015; 29: 210-5.
Published
2017-12-17