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Step by step video of robotic laparoscopic combined abdominal mesh sacrocolpopexy with ventral mesh rectopexy
IUGA Academy. Nessi A. Jun 30, 2018; 213254; 249 Topic: Pelvic Organ Prolapse
Aude Nessi
Aude Nessi

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249

Step by step video of robotic laparoscopic combined abdominal mesh sacrocolpopexy with ventral mesh rectopexy

Nessi, A1; Hahnloser, D1; Achtari, C1

1: CHUV

Introduction: For over decades abdominal mesh sacrocolpopexy has become the gold standard treatment for apical prolapse. Minimally invasive approaches such as laparoscopy and robotic assisted surgery have both been demonstrated to be feasible with similar anatomic results and are gaining popularity amongst colorectal, gynecologic and urologic surgeons. Ventral mesh rectopexy is a technique to treat advanced rectocele, intra rectal instussusception and rectal prolapse. This kind of surgery is performed internationally and this procedure is now the treatment of choice for this disease (1).

Introduction: To create a step-by-step video to be used as a didactic training tool, describing the different surgical steps of robotic laparoscopic abdominal mesh sacrocolpopexy associated with ventral mesh rectopexy attached to the sacral promontory.

Methods:The video describes a 54 years old otherwise healthy woman, who has been operated on a Burch colposuspension for stress urinary incontinence 5 years earlier. Her main complaints are anterior and apical prolapse associated with and ano rectal symptoms such as obstructed defecation syndrome and digital maneuvers to exonerate. POP-Q testing demonstrated a C2H2R3 prolapse. Pre operatively we performed an MRI defecography showing descending perineum associated with rectocele and intra anal intussusception. A gynecologist and a colorectal surgeon operated this woman on jointly. In this video, the gynecologist starts the intervention with sub total hysterectomy and bilateral adnexectomy. We use a monopolar loop in order to cut the cervix. The uterus was morcellated subsequently. Next we perform the dissection of the vesicovaginal space. A flexible retractor inserted vaginally guided the dissection. We attach a cone shaped polypropylene mesh with absorbable sutures in the lower third of the vagina under the vesical trigone. This step aims at correcting the anterior compartment prolapsed (2). The visceral surgeon then opens the peritoneum overlying the lower part of the promontory and pursues dissection down to the right utero sacral ligament. A malleable vaginal retractor is used to expose the recto vaginal wall. The Douglas pouch is incised and the rectovaginal space is dissected along the anterior rectal wall down to the anorectal junction. To perform the rectopexy we use Cellis ®, a biological pre-cut implant made of porcine collagen dermis attached to the rectum with non-absorbable stitches. We then solidarise these two meshes with the cervical stump using non-absorbable stitches. Before beginning peritonization the meshes are fixed to the sacral promontory. We usually leave a urinary catheter for 24h hours.

Conclusions: Sacrocolpopexy can easily be combined with ventral mesh rectopexy during the same procedure. It allows to treat pelvic organ and rectal prolapse at the same time.

  1. WJG 2016, 10.3748/Wjg.v22.i21.4977 10.3748 10
  2. Jchirv 2014 vol 152 10.1016

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Work supported by industry: no.

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