10-step approach for laparoscopic pectopexy combined with supracervical hysterectomy.

Abstract

Background: Apical prolapse, characterised by the descent of the vaginal apex, uterus, or cervix, is commonly treated by laparoscopic sacrocolpopexy, the current gold standard. Laparoscopic pectopexy (LP) has emerged as an effective alternative, particularly advantageous for obese patients due to its technical approach.

Objectives: To demonstrate a standardised 10-step surgical technique for performing laparoscopic pectopexy combined with supracervical hysterectomy, aiming to provide a safe and reproducible method for the treatment of apical prolapse.

Participant: A 68-year-old female patient presenting with symptomatic, advanced apical pelvic organ prolapse (POP-Q stage IV) consented to the procedure.

Intervention: The patient underwent LP following a 10-step surgical protocol: (1) division of the round ligaments and dissection towards the pelvic sidewall, (2) identification of the iliopectineal ligament, (3) division of the uterovesical peritoneum and development of the vesicovaginal space, (4) supracervical hysterectomy, (5) opening of the rectovaginal space, (6) closure of the cervical canal, (7) mesh insertion and fixation to cervix, anterior and posterior vagina, (8) bilateral anchoring of the mesh lateral arms to the iliopectineal ligaments, (9) closure of the overlying peritoneum, and (10) morcellation of the uterine corpus. The surgery was completed with minimal blood loss and no intraoperative complications.

Conclusions: LP combined with supracervical hysterectomy is a safe, effective, and reproducible surgical option for apical prolapse repair, demonstrating favourable perioperative outcomes and early discharge.

What is new?: This video-based demonstration introduces a standardised 10-step approach to LP combined with supracervical hysterectomy, facilitating adoption of this technique by surgeons with advanced minimally invasive skills, and highlighting its potential benefits, especially in obese patients.