Stepwise Laparoendoscopic Single-site Pectopexy for Pelvic Organ Prolapse

Abstract

To demonstrate stepwise techniques for the successful use of the laparoendoscopic single-site surgery (LESS) technique for safely performing pectopexy. Design: Stepwise demonstration with narrated video footage (Canadian Task Force classification III). Setting: An academic tertiary care hospital. Interventions: Patient was a 48-year-old, gravida 2 para 2, having had 2 normal spontaneous vaginal deliveries, with stage III anterior vaginal prolapse and stage III uterine prolapse and posterior vaginal prolapse. The preoperative vaginal length was 6 cm. Laparoscopic sacrocolpopexy is the current gold standard for pelvic organ prolapse demonstrating a low recurrence rate; however, it can be technically challenging to perform, particularly in women with obesity or in the event of an anatomic variation. The pectineal ligament, also known as Cooper's ligament, is familiar to surgeons and can be used for a tension-free mesh suspension in patients with prolapse. Integration of LESS and pectopexy is a novel alternative, minimally invasive approach that is more cosmetic, simpler, and effective. The key steps in LESS pectopexy include the following: LESS total laparoscopic hysterectomy with bilateral salpingectomy.Anterior and posterior vaginal cuff dissection. Exposure of the iliopectineal ligament (Cooper's ligament). Tension-free mesh anchoring. Reperitonealization. Measurements and Main Results: The procedure was performed successfully in approximately 80 minutes with a postoperative vaginal length of 6 cm. Postoperative pelvic organ prolapse quantification was stage 0. Conclusion: LESS is a feasible technique for pectopexy in patients with pelvic organ prolapse. A LESS pectopexy results in better cosmesis and offers an alternative for patients with challenging pelvic organ prolapse, such as those with obesity.

Comparative analysis of transvaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site sacrocolpopexy for pelvic organ prolapse: A propensity score matching study

“…Recent development in the NOTES technology has led to a gradual increase in the articles on vNOTES-SC and LESS-SC application for POP treatment [ [14] , [15] , [16] , [17] ]. However, based on our literature review, our study is the first to compare vNOTES-SC and LESS-SC surgeries with a follow-up of 3 years or more.…”

Clinical Comparison of 5mm Mini-incision Laparoendoscopic Single-Site Hysterectomy and Traditional Laparoendoscopic Single-Site Hysterectomy

“…In recent years, Laparoendoscopic Single-Site Surgery (LESS) has been rapidly developed, which further amplify the advantages of laparoscopy, such as small trauma, quick recovery and light postoperative pain. The feasibility of LESS have been confirmed by a large number of studies, Robotic LESS and vaginal natural orifice transluminal endoscopic surgery (vNOTES) [1][2][3][4][5]. However, there are also some scholars who believe that LESS has no obvious advantages over traditional porous laparoscopy [6,7].…”