Laparoscopic Anterior Colporraphy

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Essential equipment: 

  • 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

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SPIRE Hospital, Bristol. 
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