Laparoscopic Mesh-less Pectopexy for Uterine Prolapse with Simultaneous Total Laparoscopic Hysterectomy: Surgical Technique
GYNECOLOGY AND MINIMALLY INVASIVE THERAPY, vol.14, no.3, pp.279-280, 2025 (ESCI, Scopus)
- Publication Type: Article / Technical Note
- Volume: 14 Issue: 3
- Publication Date: 2025
- Doi Number: 10.4103/gmit.gmit-d-24-00023
- Journal Name: GYNECOLOGY AND MINIMALLY INVASIVE THERAPY
- Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, Directory of Open Access Journals
- Page Numbers: pp.279-280
- Kütahya Health Sciences University Affiliated: Yes
Abstract
OBJECTIVE
To describe the surgical steps of laparoscopic pectopexy without the use of a mesh, following total laparoscopic hysterectomy (TLH).
DESIGN
Narrated surgical video. Local institutional review approval not required, patient consent was obtained.
PATIENT
A 47-year-old, multiparous patient was admitted to the hospital with abnormal uterine bleeding and a 6-cm uterine fibroid. She also had pelvic organ prolapse (POP) and her POP-Q score was as follows; Aa: 1, Ba: +1, C: +2, Ap: 1, Bp: 2, D: 1.[1]
INTERVENTIONS
Routine TLH and bilateral salpingo-oophorectomy (not demonstrated), followed by mesh-less pectopexy to correct apical prolapse.
RESULTS
Mesh-less pectopexy following TLH can be performed safely by following those steps [Video]: (1) Peritoneal incision from the right end of the vaginal cuff to the level of the right pectineal ligament. (2) Identification of the pectineal ligament lateral to the medial umbilical ligament on the right side. (3) Repetition of steps 1 and 2 on the opposite side. (4) Passing of a nonabsorbable monofilament polypropylene suture (Prolene 0, Ethicon Inc; Johnson and Johnson, Somerville, NJ, USA) through the pectineal ligament and knotting on one side (5) Passing the suture through the vaginal cuff two or three times and tying with sufficient tension. (6) Repetition of steps 4 and 5 on the opposite side. (7) Closure of the parietal peritoneum with absorbable, knotless suture (V-loc™, Covidien, Inc, Mansfield, Massachusetts) [Figure 1].
Video Article
Laparoscopic Mesh-less Pectopexy for Uterine Prolapse with Simultaneous Total Laparoscopic Hysterectomy: Surgical Technique
- Open
- Associated Video
OBJECTIVE
To describe the surgical steps of laparoscopic pectopexy without the use of a mesh, following total laparoscopic hysterectomy (TLH).
DESIGN
Narrated surgical video. Local institutional review approval not required, patient consent was obtained.
PATIENT
A 47-year-old, multiparous patient was admitted to the hospital with abnormal uterine bleeding and a 6-cm uterine fibroid. She also had pelvic organ prolapse (POP) and her POP-Q score was as follows; Aa: 1, Ba: +1, C: +2, Ap: 1, Bp: 2, D: 1.[1]
INTERVENTIONS
Routine TLH and bilateral salpingo-oophorectomy (not demonstrated), followed by mesh-less pectopexy to correct apical prolapse.
RESULTS
Mesh-less pectopexy following TLH can be performed safely by following those steps [Video]: (1) Peritoneal incision from the right end of the vaginal cuff to the level of the right pectineal ligament. (2) Identification of the pectineal ligament lateral to the medial umbilical ligament on the right side. (3) Repetition of steps 1 and 2 on the opposite side. (4) Passing of a nonabsorbable monofilament polypropylene suture (Prolene 0, Ethicon Inc; Johnson and Johnson, Somerville, NJ, USA) through the pectineal ligament and knotting on one side (5) Passing the suture through the vaginal cuff two or three times and tying with sufficient tension. (6) Repetition of steps 4 and 5 on the opposite side. (7) Closure of the parietal peritoneum with absorbable, knotless suture (V-loc™, Covidien, Inc, Mansfield, Massachusetts) [Figure 1].
Total operative time was 80 min (40 min for laparoscopic mesh-less pectopexy). Estimated blood loss was 50 mL. Postoperatively, 500 mg cefuroxime axetil was administered orally twice daily, for a total of 5 days. The patient made an uneventful recovery. The postoperative POP-Q score,[1] at the 5-month follow-up appointment, was: Aa: 3, Ba: 6, C: 7, Ap: 2, Bp: 5, D: 7.
CONCLUSION
We, hereby, describe the surgical steps of laparoscopic mesh-less pectopexy, performed simultaneously with TLH. The combined procedure may be particularly useful in patients with uterine prolapse and co-existent indications for TLH. Laparoscopic pectopexy was developed as an alternative method to sacrocolpopexy.[2-4] In the original method, the cervix uteri or vaginal cuff is suspended to the pectineal ligament bilaterally using a mesh. The use of oak poses risks such as that of erosion.[5] Some modifications of the original technique using mersilene tape or polyester sutures instead of a mesh to prevent erosion have been described.[6,7] However, data are limited. Laparoscopic mesh-less pectopexy can, also, be performed in cases of vaginal vault prolapse. The mesh-less modification of laparoscopic pectopexy with prolene sutures is a safe and reproducible method, eliminating the risk of mesh erosion, especially in cases with simultaneous hysterectomy.
OBJECTIVE
To describe the surgical steps of laparoscopic pectopexy without the use of a mesh, following total laparoscopic hysterectomy (TLH).
DESIGN
Narrated surgical video. Local institutional review approval not required, patient consent was obtained.
PATIENT
A 47-year-old, multiparous patient was admitted to the hospital with abnormal uterine bleeding and a 6-cm uterine fibroid. She also had pelvic organ prolapse (POP) and her POP-Q score was as follows; Aa: 1, Ba: +1, C: +2, Ap: 1, Bp: 2, D: 1.[1]
INTERVENTIONS
Routine TLH and bilateral salpingo-oophorectomy (not demonstrated), followed by mesh-less pectopexy to correct apical prolapse.
RESULTS
Mesh-less pectopexy following TLH can be performed safely by following those steps [Video]: (1) Peritoneal incision from the right end of the vaginal cuff to the level of the right pectineal ligament. (2) Identification of the pectineal ligament lateral to the medial umbilical ligament on the right side. (3) Repetition of steps 1 and 2 on the opposite side. (4) Passing of a nonabsorbable monofilament polypropylene suture (Prolene 0, Ethicon Inc; Johnson and Johnson, Somerville, NJ, USA) through the pectineal ligament and knotting on one side (5) Passing the suture through the vaginal cuff two or three times and tying with sufficient tension. (6) Repetition of steps 4 and 5 on the opposite side. (7) Closure of the parietal peritoneum with absorbable, knotless suture (V-loc™, Covidien, Inc, Mansfield, Massachusetts) [Figure 1].
Video Article
Laparoscopic Mesh-less Pectopexy for Uterine Prolapse with Simultaneous Total Laparoscopic Hysterectomy: Surgical Technique
- Open
- Associated Video
OBJECTIVE
To describe the surgical steps of laparoscopic pectopexy without the use of a mesh, following total laparoscopic hysterectomy (TLH).
DESIGN
Narrated surgical video. Local institutional review approval not required, patient consent was obtained.
PATIENT
A 47-year-old, multiparous patient was admitted to the hospital with abnormal uterine bleeding and a 6-cm uterine fibroid. She also had pelvic organ prolapse (POP) and her POP-Q score was as follows; Aa: 1, Ba: +1, C: +2, Ap: 1, Bp: 2, D: 1.[1]
INTERVENTIONS
Routine TLH and bilateral salpingo-oophorectomy (not demonstrated), followed by mesh-less pectopexy to correct apical prolapse.
RESULTS
Mesh-less pectopexy following TLH can be performed safely by following those steps [Video]: (1) Peritoneal incision from the right end of the vaginal cuff to the level of the right pectineal ligament. (2) Identification of the pectineal ligament lateral to the medial umbilical ligament on the right side. (3) Repetition of steps 1 and 2 on the opposite side. (4) Passing of a nonabsorbable monofilament polypropylene suture (Prolene 0, Ethicon Inc; Johnson and Johnson, Somerville, NJ, USA) through the pectineal ligament and knotting on one side (5) Passing the suture through the vaginal cuff two or three times and tying with sufficient tension. (6) Repetition of steps 4 and 5 on the opposite side. (7) Closure of the parietal peritoneum with absorbable, knotless suture (V-loc™, Covidien, Inc, Mansfield, Massachusetts) [Figure 1].
Total operative time was 80 min (40 min for laparoscopic mesh-less pectopexy). Estimated blood loss was 50 mL. Postoperatively, 500 mg cefuroxime axetil was administered orally twice daily, for a total of 5 days. The patient made an uneventful recovery. The postoperative POP-Q score,[1] at the 5-month follow-up appointment, was: Aa: 3, Ba: 6, C: 7, Ap: 2, Bp: 5, D: 7.
CONCLUSION
We, hereby, describe the surgical steps of laparoscopic mesh-less pectopexy, performed simultaneously with TLH. The combined procedure may be particularly useful in patients with uterine prolapse and co-existent indications for TLH. Laparoscopic pectopexy was developed as an alternative method to sacrocolpopexy.[2-4] In the original method, the cervix uteri or vaginal cuff is suspended to the pectineal ligament bilaterally using a mesh. The use of oak poses risks such as that of erosion.[5] Some modifications of the original technique using mersilene tape or polyester sutures instead of a mesh to prevent erosion have been described.[6,7] However, data are limited. Laparoscopic mesh-less pectopexy can, also, be performed in cases of vaginal vault prolapse. The mesh-less modification of laparoscopic pectopexy with prolene sutures is a safe and reproducible method, eliminating the risk of mesh erosion, especially in cases with simultaneous hysterectomy.