Abstract
Laparoscopic sacrocolpopexy (LSC) is one of the surgical treatments for pelvic organ prolapse (POP). We started LSC in 2017. In the LSC surgical procedures, incision of retroperitoneal in front of the sacral promontory and exposure of the anterior longitudinal ligaments is a unique procedure that cannot be handled by other gynecological laparoscopic surgery. The common iliac artery and vein cross in front of the sacral promontory, and the median sacral artery and vein also run longitudinally, and sometimes the inferior vena cava is present down to the sacral promontory. Vascular plexus is complicated and there are many variations. Then, if hemorrhage occurs, it is not easy to stop bleeding.
In the field of view from the umbilicus, depending on the sacral morphology, there are many cases where the position of mesh fixation cannot be sufficiently observed, so preoperative evaluation was considered useful. Evaluation of blood vessels around the sacrum is particularly important in LSC where the mesh is fixed at the sacrum promontory. From the time of introduction, we have been using 3D computerized tomography (3D-CT) to grasp the mesh fixation position on the front surface of the sacrum in three dimensions. In addition, we constructed the view from the first trocar to capture the actual operative field view. We examined 15 patients who underwent 3D-CT and found that the area of the avascular region in front of the sacrum promontory was significantly narrower in 3D-CT view from the first trocar compared with it of open surgery.
As a preoperative evaluation of LSC, we will evaluate and show the usefulness of 3D-CT.
