Objective: This video illustrates key technical steps and refined strategies to improve safety, precision, and reproducibility when performing Laparoscopic Lateral Suspension (LLS) for the treatment of pelvic organ prolapse (POP) [1]. Setting: This video includes intraoperative laparoscopic video footage performed at the Division of Gynecology and Obstetrics at the University Hospital of Cagliari, Italy. Participants: The case presented involves different women with stage II-III cystocele and apical prolapse, with preserved uterine anatomy and no significant posterior compartment defect. Interventions: All patients underwent LLS to surgically treat POP using a T-shaped prosthetic mesh fixed to the uterine cervix or isthmus and the anterior vaginal wall, with arms suspended retroperitoneally and tension-free to the lateral abdominal wall. The procedure included six tips and techniques: bladder suspension technique to the anterior abdominal wall with the use of a Foley segment [2]; accurate measurement of the anterior vaginal wall with a segment of a Foley catheter; optimal mesh tailoring; use of a 10-mm suprapubic trocar; application of the first stitch on the anterior vaginal wall; and peritoneum traction to improve procedural outcomes. These steps were presented as a standardized, step-by-step process to improve intraoperative exposure, control mesh deployment and arm traction, and enhance overall reproducibility of LLS. Conclusion: LLS may be an alternative to laparoscopic sacral colpopexy, particularly for cystocele and apical prolapse repair when promontory access is difficult [3-5]. The refinements presented here aim to increase reproducibility and intraoperative control during vesicovaginal dissection, mesh sizing, and retroperitoneal tunneling. The dual use of a Foley segment for atraumatic bladder retraction and standardized measurement offers a low-cost strategy, while stepwise mesh deployment and gentle peritoneal traction support safe, consistent suspension.
Laparoscopic Lateral Suspension According to Dubuisson: Technical Video Guide with Tips and Tricks
Michele, Stefano Di
Primo
;Caiazzo, Alessandro;D'Alterio, Maurizio Nicola;Angioni, StefanoUltimo
Conceptualization
In corso di stampa
Abstract
Objective: This video illustrates key technical steps and refined strategies to improve safety, precision, and reproducibility when performing Laparoscopic Lateral Suspension (LLS) for the treatment of pelvic organ prolapse (POP) [1]. Setting: This video includes intraoperative laparoscopic video footage performed at the Division of Gynecology and Obstetrics at the University Hospital of Cagliari, Italy. Participants: The case presented involves different women with stage II-III cystocele and apical prolapse, with preserved uterine anatomy and no significant posterior compartment defect. Interventions: All patients underwent LLS to surgically treat POP using a T-shaped prosthetic mesh fixed to the uterine cervix or isthmus and the anterior vaginal wall, with arms suspended retroperitoneally and tension-free to the lateral abdominal wall. The procedure included six tips and techniques: bladder suspension technique to the anterior abdominal wall with the use of a Foley segment [2]; accurate measurement of the anterior vaginal wall with a segment of a Foley catheter; optimal mesh tailoring; use of a 10-mm suprapubic trocar; application of the first stitch on the anterior vaginal wall; and peritoneum traction to improve procedural outcomes. These steps were presented as a standardized, step-by-step process to improve intraoperative exposure, control mesh deployment and arm traction, and enhance overall reproducibility of LLS. Conclusion: LLS may be an alternative to laparoscopic sacral colpopexy, particularly for cystocele and apical prolapse repair when promontory access is difficult [3-5]. The refinements presented here aim to increase reproducibility and intraoperative control during vesicovaginal dissection, mesh sizing, and retroperitoneal tunneling. The dual use of a Foley segment for atraumatic bladder retraction and standardized measurement offers a low-cost strategy, while stepwise mesh deployment and gentle peritoneal traction support safe, consistent suspension.
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