Nerve-Sparing Laparoscopic Colposacropexy Using a Percutaneous Surgical System: A Case Report.

Study Objective: The primary aim of this study was to evaluate the feasibility, efficacy, and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2.9-mm Percuvance percutaneous surgical system (PSS; The Percuvance System; Teleflex Inc., Wayne, PA). The secondary aim was to investigate the technical performance of these instruments as needle holder in the placement of the mesh. The final aim was to establish the rate of prolapse recurrence.

Design: Step-by-step video demonstration of the surgical technique.

Setting: The Internal Department Committee approved this study.

Patient: The patient was adequately informed about the possible risks and benefits of this experimental technique, and a written consent agreeing to undergo the described procedure was signed.

Intervention: Nerve-sparing laparoscopic colposacropexy with positioning of two polypropylene titanized meshes and concomitant subtotal hysterectomy and salpingo-oophorectomy entirely performed with a 2.9-mm PSS.

Measurements And Main Results: Pelvic organ prolapse is a condition affecting up to 50% of multiparous women. It may be considered a significant public health problem with an important impact on general health-related quality of life. A conservative and/or medical treatment may be considered only for women with a mild degree of prolapse, women with a reproductive desire, or women unable to undergo surgery. In the remaining cases, surgery seems to be the most effective treatment. The surgical approach may be abdominal (colposacropexy by laparotomy, laparoscopy, or robot-assisted) or vaginal (autologous or prosthesic reinforcement). The aims of the surgical procedures include not only the anatomic correction of the prolapse but also the improvement of patient quality of life and prolapse symptom relief, guaranteeing normal bladder, bowel, and sexual functions and avoiding iatrogenic dysfunctional symptoms. At present, the laparoscopic technique of sacral colpopexy offers a number of important advantages, including an excellent visualization of the pelvis, reduction in adhesions formation, and decreased postoperative pain and recovery, with reported success rates of 90% to 96% with a mesh erosion rate of 1% to 8%.

Conclusion: This case report is the first to report a nerve-sparing laparoscopic colposacropexy performed with a 2.9-mm PSS. The major advance of this technique is the possibility of performing a major gynecologic surgery with a scarless approach, which results in fewer traumas for the patient in the postoperative time. The use of these instruments does not increase the operation time or the rate early or late complications, most of all prolapse recurrence. Considering that this is the first case report in literature, more clinical data are needed to confirm these findings.