Laparoscopic Myomectomy in Pregnancy

Abstract

Objective: To show the technique of robotic repair of pelvic floor defect including apical and anterior compartment defect and enterocele. To emphasize the importance of management of enterocele with apical suspension procedure. Design: A video demonstrating the step by step technique of mid-uterosacral ligament suspension procedure. Settings: University Affiliated Teaching Hospital with MIGS fellowship program. Patients: Pelvic organ prolapse patients with previous hysterectomy. Interventions: Robotic repair of pelvic floor defect in multiple compartments using a permanent suture. Measurements/Results: Pelvic floor defects can be efficiently managed with robotic apical suspension procedure in a patient with previous hysterectomy. We simultaneously address the enterocele as well as anterior and posterior compartment defect laparoscopically. Isolated anterior or posterior repair is rarely useful unless the apical defect is addressed. If the native uterosacral ligament has good strength to hold the suspension stitch, mesh use can be precluded. Minimally invasive gynecologic surgeons can gain proficiency in this surgery by utilizing the key techniques and steps mentioned in this video. This procedure is very useful as it repairs defects in multiple compartments without using a mesh. Conclusions: Pelvic organ prolapse consisting of apical, anterior, posterior defect and enterocele can be effectively managed with robotic miduterosacral ligament suspension using a permanent suture, if native tissue has good strength; thus precluding the use of a mesh.