Laparoscopic Vaginal Sacrocolpopexy
Bristol Laparoscopic Associates have been performing day case laparoscopic sacral colpopexy for over 10 years.
NB. The vast majority of post hysterectomised (and many non-hysterectomy) patients have concurrent problems with an occult full thickness rectal prolapse. In these patients we employ the laparoscopic ventral rectopexy approach which addresses both problems.
- one 5mm, two 12mm disposable trocars
- One 5mm fenestrated Johan grasping forceps
- Two 5mm needle holder
- Scissors or dissecting hook
- 5mm Protacker
- 10 x 2 cm prolene mesh
- 1/0 Ethibond sutures (12cm length)
- D&C set/Sprackman if there is a uterus present.
- Vaginal trainer
Use gravity as much as possible ie steep head down tilt and always use a 30 degree scope. Cover the surgery with appropriate antibiotics.
After placing three small incisions (5 & 2mm on right hand side, one 12mm through the umbilical tubethe access ports and the laparoscope, the bowel is mobilized out of the pelvis and the sacrum identified. The overlying peritoneum is elevated and then incised.
A vaginal trainer is then inserted into the vagina from below to elevate the apex or vaginal vault into the surgical field. The peritoneum is then incised down towards the vaginal vault.
The anterior vaginal is then carefully dissected from the bladder. If you make a hole in the bladder, don't worry - repair it with 2/0 PDS and feep a catheter in-situ. The mesh (prolene or marlex), shaped like a Y is then attached using 4-6 sutures both to the posterior aspect of the vagina apex and to the anterior vaginal apex.
The long arm of the Y-mesh is then looseley pulled up to the sacrum and attached with 4 or 5 "protacks" taking care to avoid the presacral vessels and nerves.
Finally, cover the mesh with peritoneum and close the 12mm port sites.