Laparoscopic Anterior Colporraphy
- One 5mm, two 12mm disposable trocars
- One 5mm fenestrated grasping forceps
- 5mm Harmonic scalpel
- Two 5mm needle holders
- 5mm Protacker
- 15 x 4 cm prolene mesh (tapering to 1cm)
- 1/0 Ethibond sutures (12cm length)
- D&C set/Sprackman if there is a uterus present.
- Vaginal trainer for post hysterectomy pts.
Use gravity as much as possible and always use a 300 scope. Site the laparoscope through the umbilicus.
Use a medial approach to expose the sacral prominentry. Do not mobilise the neuro- vascular bundle or divide the lateral ligaments. Continue dissection as above.
A vaginal trainer enables exposure of the anterior vaginal wall. Open the peritoneum between the bladder and vagina and continue for 4cms, more if there is a large cystocele. Suture the mesh to the anterior vaginal wall with four sutures. Watch out for the bladder! If the patient has not had a hysterectomy, bring the mesh out through the uterine ligament.
Fix the mesh to the promontory and close the peritoneum. Assess tension by a vaginal examination