V1-05: Apical sling for for site specific pelvic organ prolapse repair

Video

Introductions and Objectives
Sacral colpopexy has become a widely used procedure for apical vaginal prolapse repair, but the risk of bleeding, injury of the rectum, as well as other abdominal viscera still represents a major concern. Posterior transcoccigeal mesh brings the risks of the transgluteal route, mostly pudendal neurovascular bundle injury. A new procedure for colpopexy was developed in order to allow for a single incision apical transvaginal level I repair, using a small amount of synthetic material. The kit contains a macro porous polypropylene 8 x 1,2 cm tape and two polypropylene self anchoring system attached to polypropylene threads and a disposable retractable insertion guide for placement of the anchoring system into the sacrospinous ligaments. This video highlights the technical details of the procedure.

Methods
It is presented the surgical treatment of a patient with a vaginal apical (uterine) prolapse stage 3 according to the POP-Q system. A vertical incision is done in the anterior vaginal. Blunt dissection is performed towards the ischial spine, and coccigeous muscle and sacrospinous ligaments are identified bilaterally. Then, the retractable insertion guide is primed with the multipoint anchoring system and introduced toward the ischial spine guided by surgeon’s index finger and implanted into the sacrospinous ligament, 1.5 cm medial to ischial spine. The tissue anchoring system is delivered and the retractable insertion guide is gently retracted. Next reconstruction of the pericervical ring is performed. then, both sides of the sling are attached to the polypropylene threads and knots are tied in order to elevate the cervix and the vaginal apex to DeLancey’s level one. Finally, the vaginal incision is closed in the usual manner.

Results
This procedure was performed in 10 patients (mean age 65 years-old) with POP-Q stage 3 apical prolapse. No intra-operative complications or postoperative significant adverse events were observed. None presented post-operative vaginal mesh exposure. Mean follow up was 12 months (6 to 18 months). In this short term follow up, all of the patients were considered cured (POP-Q apical stage was 0 or 1).

Conclusions
Apical sling kit adds the advantages of single incision transvaginal approach, safety and level I correction of apical defect, without the mesh related complications.

Funding: None.