Transvaginal Single-Port Laparoscopy Pelvic Reconstruction with Y-Shaped Mesh.

STUDY

OBJECTIVE

To demonstrate a new technique for pelvic reconstruction in patients with multiple-compartment pelvic organ prolapse (POP) using Y-shaped mesh via transvaginal single-port laparoscopy.

DESIGN

Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III).

SETTING

It is more and more prudent for pelvic floor reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of pelvic reconstruction via natural orifice transluminal endoscopic surgery is feasible.

INTERVENTIONS: The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm "window" of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the pelvic peritoneum was closed, a "window" of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up.

CONCLUSION

Transvaginal single-port laparoscopic pelvic reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.