Minimally invasive surgery for pelvic organ prolapse is a time to redefine the minimally invasive technique. We found that our technique improves overall patient satisfaction, decreases length of hospital stay, decreases opioid use, and has been used with combined other gynecologic and colorectal procedures. Costs for pelvic organ prolapse and treatment may reach up to a billion dollars within the next several years. Pelvic organ prolapse has significant impacts on patients with physical, sexual, and emotional health. Current gold standard for treatment is the abdominal sacral copepaxi. Minimally invasive surgery is the use of small incisions to perform operations while viewing the procedure from a video screen. Minimally invasive surgery has decreased the need for post-op analgesia, there's less blood loss, lower infection rates, and shorter hospital stays. What then defines a minimally invasive incision? Below outlines the crystal incision used in the procedure. The surgical site is prepped and draped, and the incision is then measured out. The incision is measured 2-3 cm above the pubic symphysis, and then 5 cm in the transverse direction. The scalpel is used to open the skin, and an electrocautery is used to dissect tissue down to the level of the fascia. A small vertical incision is made on the fascia to make the Kusner incision. After incision is made, self-retracting retractors are then used. We prefer to use the Alexis Wound Retractor or the O'Connor O'Sullivan. Here, the Alexis Wound Retractor is used to provide a circumferential, non-traumatic, maximum retraction with a small incision. This retractor has been proven in several surgical specialties. Once the Alexis Wound Retractor has been placed, the patient is then put in Trendelenburg position. The use of tagged moist lab pads are placed intra-abdominally to manipulate the bowel and improve visualization. If the patient has a significant history, vaginal procedures, or dense adhesions, general surgery, or colorectal surgery can be on standby. Hysterectomy is then performed in the usual technique. Good visualization and manipulation can be done throughout the procedure. Lancashire Bipolar Potter is used to decrease surgical time and decrease blood loss. The uterus is then removed from the abdominal cavity. Larger sized uteri from adenomyosis or fibroids may have to be removed in segments, as we see here. Use of a lightweight, large-pore polypropylene mesh in a Y-shape is then used to attach to the cervical stump on the anterior and posterior sides of the cervix. Use of an EE Ascizer in the vagina will help to differentiate the vagina from the rectum. This is especially true in patients with a prior total hysterectomy. Preplaced sutures are used to guide the mesh onto the anterior or posterior aspects of the cervix. The mesh is then secured after tying of each suture. We then expose the peritoneum over the sacrum. A malleable retractor and sponge stick are used to manipulate and hold back the sigmoid colon to improve visualization. A small vertical incision is then made with electrocautery and any vessels are ablated. Once the anterior longitudinal ligament is visualized, the mesh is attached to S2 to S3 with the use of the PROTAC stapler. The mesh is then tested for secureness on the sacrum and then peritoneum is stitched over the exposed mesh. Before abdominal closure, cystoscopy is performed. During cystoscopy, we check for any sutures in the bladder and for adequate flow from both ureters. After cystoscopy, abdominal closure is then performed. Once the skin is closed and the procedure is complete, anesthesia then gives a tap block for improved pain control in the postoperative period. After the surgery, patients are able to get regular diet. Ambulation is encouraged within 8 hours. There is a voiding trial the next morning and pending patient stability. They are able to go home post-op day 1.

minimally invasive surgery

pelvic organ prolapse

patient satisfaction

abdominal sacral colpoperineopexy

polypropylene mesh