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Laparoscopic sacrocolpopexy is a minimally invasive surgery to treat pelvic organ prolapse using a laparoscope
Laparoscopic sacrocolpopexy is a minimally invasive surgery to treat pelvic organ prolapse using a laparoscope (a thin, long, flexible instrument with a camera and light source at one end). Pelvic organ prolapse is a condition in which the structures that support the pelvic organs (the pelvic floor) become weak. The pelvis is the area between the hip bones and harbors the pelvic organs, which include the uterus, cervix, vagina, intestines, rectum, urinary bladder, and urethra. Any of these organs can sag or slip downwards (prolapse) when their supporting muscles and ligaments become weak, torn, or stretched.
Depending on the structure prolapsed, pelvic organ prolapse may be:
- Uterine prolapse: This refers to the prolapse of the uterus and cervix (neck of the uterus) down the vagina. In severe cases, the prolapsed parts may come out through the vaginal opening.
- Vaginal vault prolapse: This type of prolapse can occur in women who underwent surgery for the removal of the uterus (hysterectomy). Following hysterectomy, the top of the vagina is repaired to form a vaginal vault. During vault prolapse, the vaginal vault drops down the vaginal canal.
- Cystocele: In this condition, the bladder bulges into the vagina.
- Rectocele: In this condition, the rectum (the last part of the large bowel) bulges into the vagina.
- Enterocele: This refers to the bulging of the small bowel against the vaginal wall. This can occur along with a vaginal vault prolapse.
What happens during a laparoscopic sacrocolpopexy?
A laparoscopic sacrocolpopexy surgery involves the strengthening of the pelvic floor. During the surgery, a surgical mesh is attached from the vagina to the tailbone (sacrum). The uterus may be removed if needed with or without the removal of the cervix. Depending on the patient’s age, consent, and family history, the fallopian tubes and/or ovaries may also be removed.
During a laparoscopic sacrocolpopexy:
- The anesthesiologist establishes the IV line.
- General anesthesia is given to the patient (the patient sleeps during the procedure).
- The surgeon cleans the area to be operated on and makes four to five small cuts on the abdomen.
- Carbon dioxide gas is used to inflate the abdomen, which creates a better view and space for the surgery.
- The surgeon passed a laparoscope (a thin, flexible, tube-like instrument with a camera and a light source) through one of the incisions. Other instruments are passed through the remaining incisions.
- The surgeon attaches a piece of surgical mesh to the front and back walls of the vagina and then to the sacrum. This suspends the top of the vagina or the cervix back into its normal position.
- The supports of the bladder and/or the rectum may also be strengthened if needed.
- In patients with an inability to control urine (urinary incontinence), a small piece of the mesh may be placed underneath the urethra (the tube that carries urine) to give support when the patient laughs, sneezes, or coughs.
- The surgeon ensures that there are no injuries at the end of the surgery through a small camera that examines the inside of the bladder.
What are the risks of a laparoscopic sacrocolpopexy?
The risks associated with a laparoscopic sacrocolpopexy are:
- Pain
- Difficulty in passing urine
- Bleeding and bruising
- Delayed wound healing
- Wound infections
- Urinary tract infection (UTI)
- Deep vein thrombosis (blood clots in the deep veins of the legs or the lungs)
- Injury to the bladder/bowel