Laparoscopic Lateral Suspension: Benefits of a Cross-shaped Mesh to Treat Difficult Vaginal Vault Prolapse

Abstract

Study objective: To show an original technique of laparoscopic lateral suspension (LLS) with a precut mesh in a difficult case of vaginal vault prolapse.

Design: Step-by-step descriptions of the technique using videos (educational video).

Setting: Vaginal vault prolapse affects up to 1% of patients who had a hysterectomy. Sacrocolpopexy is considered the gold standard in the treatment of apical pelvic organ prolapse. However, dissection at the level of the promontory may be challenging, particularly in obese patients or when an anatomic variation exists. This may be associated with rare but serious neurologic or ureteral morbidity as well as life-threatening vascular injury. LLS with mesh represents an alternative procedure, avoiding dissection at the promontory. The originality of this video is to describe the procedure of LLS in a difficult case of vaginal vault prolapse related to adhesions and difficulties of fascia cleavage. The use of a precut cross-shaped mesh simplified the technique and facilitated the attachment of the mesh to the fascia and the lateral suspension for a smaller period of time. This point is not negligible, especially in cases with technical difficulties. Institutional review board approval was obtained through the local ethics committee of Geneva University Hospitals (Canadian Task Force classification III).

Interventions: After dissections, positioning of the mesh on the dome and on the anterior and posterior vaginal walls is explained. The out-in technique of lateral suspension with the specific mesh is described.

Conclusion: In this difficult case of vaginal vault prolapse, the LLS using a precut cross-shaped mesh was placed in good conditions, providing the patient with a minimum risk of complications and with the benefits of minimally invasive approach.

Keywords: Cross-shaped mesh; Laparoscopy; Lateral suspension; Vaginal vault prolapse.