Transvaginal single-port laparoscopic-assisted vaginal sacral fixation

Abstract

: It is estimated that the incidence of pelvic floor dysfunction disease in women over 50 years old is 50%. The aim of treatment for pelvic floor dysfunction is to alleviate symptoms and reconstruct the normal pelvic anatomy in order to improve the quality of life. The surgical methods are various and can be divided into traditional surgery and reconstruction surgery. Reconstruction surgery includes sacral fixation, sacrospinal ligament fixation, high uterosacral ligament suspension, and pelvic floor reconstruction with synthetic mesh. In addition to these, sacrocolpopexy has been widely used in clinical treatment for apical compartment prolapse as one of the classic methods. At present, it is usually completed using an abdominal or laparoscopic method with mesh, but the mesh is a foreign body, which may lead to many complications arising from mesh exposure and erosion. We have been performing transvaginal vaginal sacral fixation with 2 absorbable sliding lines instead of the patch to suspend the vaginal stump on the anterior longitudinal ligament in front of the sacrum. However, due to the need to establish a special surgical position, the use of special lengthening instruments, and the high requirements of teamwork, a limited number of these operations have been completed over the past few years. Recently, different surgical approaches have emerged, especially single-port laparoscopy. With the popularity of the minimally invasive concept and the continuous development of single-port laparoscopic technology, minimal invasiveness, good aesthetic appearance, rapid recovery, and maintaining treatment effectiveness, are the new requirements for our operations. Therefore, we aimed to complete the operation with the aid of transvaginal single-port laparoscopy. The combination of vaginal surgery and laparoscopic surgery avoids the drawbacks in vaginal surgery of a small visual field and exposure difficulties and allows for laparoscopy to be performed under direct vision, which improves the safety of the operation. Furthermore, no scar is left on the body surface, operation-related pain is reduced, the appearance of the body is improved, and rapid recovery is promoted. Here, we describe transvaginal single-port laparoscopic-assisted vaginal sacral fixation.