Laparoscopic lateral suspension is an alternative surgical method when there is difficulty in dissection of the promontory of the sacrum due to abnormal vasculature in laparoscopic sacrocolpopexy: A case report

Abstract

　Laparoscopic sacrocolpopexy (LSC) is becoming a popular surgical method for patients with pelvic organ prolapse. It is associated with a lower rate of recurrence and higher rate of patient satisfaction. Dissecting the peritoneum on the promontory of the sacrum to expose the anterior longitudinal ligament is an essential part of this surgery. However, there are some cases in which we cannot perform this procedure due to anatomical anomalies. Laparoscopic lateral suspension (LLS) is another surgical procedure for patients with pelvic organ prolapse. It involves the anchoring and suspension of a mesh, without exposing the longitudinal ligament at the promontory of the sacrum. LSC was planned for a 74-year-old woman (gravida 2, para 2) with stage III pelvic organ prolapse. Preoperative magnetic resonance imaging showed that her right common iliac artery ran in front of the promontory of the sacrum, and it considered difficult to expose the anterior longitudinal ligament. The surgical method was changed from LSC to LLS with barbed suture for posterior colporrhaphy using V-Loc. The operation time was 5 hours and 37 minutes; there was little blood loss. She had an uneventful postoperative course with no recurrence at nine months after surgery. LLS with barbed suture for posterior colporrhaphy can be an effective alternative method when it is difficult to dissect the peritoneum on the promontory of the sacrum to expose the anterior longitudinal ligament in LSC.