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. 2021 Apr 30;10(2):114-116.
doi: 10.4103/GMIT.GMIT_1_20. eCollection 2021 Apr-Jun.

Measures for Safe Laparoscopic Sacrocolpopexy: Preoperative Contrast-Enhanced Computed Tomography and Perioperative Ultrasonography

Yasushi Kotani  1 , Kosuke Murakami  1 , Akiko Kanto  1 , Hisamitsu Takaya  1 , Hidekatsu Nakai  1 , Noriomi Matsumura  1
Affiliations

Measures for Safe Laparoscopic Sacrocolpopexy: Preoperative Contrast-Enhanced Computed Tomography and Perioperative Ultrasonography

Yasushi Kotani et al. Gynecol Minim Invasive Ther. .

Abstract

Laparoscopic sacrocolpopexy is one of the most difficult laparoscopic surgical techniques. In this study, we report on our efforts to safely perform this procedure, which consists of suturing a piece of mesh onto the anterior longitudinal ligament using a nonabsorbent suture during mesh fixation onto the prepromontorium layer, which can lead to massive bleeding if a mistake is made, by performing preoperative and intraoperative image evaluation. Preoperative contrast-enhanced computed tomography was performed. Images in DICOM format were acquired, and three-dimensional vessel reconstruction was performed. After performing a peritoneal incision in the presacral area, ultrasonography was performed using a probe inserted through a 12-mm trocar into the abdominal cavity to re-confirm the absence of vessels near the planned suturing area. After ultrasonography, an Ethibond® suture was inserted through the anterior longitudinal ligament. In our hospital, 126 patients underwent the procedure, and none had a serious hemorrhage or required blood transfusion, indicating the safety of this modified procedure without separation of a wide presacral area. We believe that these techniques can be performed safely with minimal incision. However, we did not examine the efficacy of these techniques in this paper. Further studies are needed to determine whether this approach is suitable.

Keywords: Computed tomography; laparoscopic sacrocolpopexy; ultrasonography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative contrast-enhanced computed tomography image. Anatomical vascular variations were examined after three-dimensional reconstruction
Figure 2
Figure 2
The absence of vessels at the suturing site was confirmed before suturing using an ultrasonography probe (drop-in probe) introduced through a trocar
Figure 3
Figure 3
Ultrasound image confirming the absence of vessels in the presacral area. (a) Image at a position where there are no blood vessels and a thread can be applied (b) Image to the right of a, where the common iliac artery is visible (c) Image to the left of a, where the common iliac vein is visible
Figure 4
Figure 4
Computed tomography image depicting the right internal iliac vein merging into the left common iliac vein
See this image and copyright information in PMC

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