Microlaparoscopy in Urogynecology: LSH and Sacrocervicopexy

摘要

Study Objective: To determine the feasibility of using only microlaparoscopic (3.5 mm) accessory instruments for performing laparoscopic supracervical hysterectomy (LSH) and sacrocervicopexy with the aid of a transcervically placed cannula for introduction of mesh and needles. Design: Retrospective evaluation of the first five cases of microlaparoscopic LSH with sacrocervicopexy (Canadian Task Force classification III). Setting: Community teaching hospital affiliated with a major teaching hospital. Patients: Five women with symptomatic uterovaginal prolapse of stage II or higher. Interventions: LSH with transcervical morcellation followed by sacrocervicopexy with all 3.5 mm instruments using synthetic mesh with anterior and posterior extensions. Measurements and Main Results: Four ports were made in all patients: a 5-mm infraumbilical port for the laparoscope and three 3.5-mm ports (right and left paraumbilical and suprapubic). LSH was performed using a 3-mm bipolar grasping device and reusable monopolar scissors. Resection of the uterus was also performed using monopolar scissors. Transcervical coring through the vagina was performed using a 15-mm serrated cylindrical blade with a central rod placed upward through the cervix, and transcervical morcellation was performed using an electromechanical morcellator. In all patients, sacrocervicopexy was performed successfully using Y-shaped polypropylene mesh, with PTFE sutures on the vagina and the sacral promontory. Reperitonealization over the mesh was performed using a running barbed absorbable suture. There were no intraoperative or postoperative complications in this group of patients. Conclusion: LSH and sacrocervicopexy using 3.5-mm accessory ports is a feasible procedure with the use of transcervical morcellation and a transcervical access cannula.