title: Laparoscopic extraperitoneal sacrospinous suspension for vaginal vault prolapse.
abstract: BACKGROUND
  A new laparoscopic sacrospinous suspension procedure is described for the correction of vaginal vault prolapse using an extraperitoneal approach. This is the first report in the literature of the extraperitoneal approach.
  
  
  METHODS
  We reviewed 12 women who had been treated in our hospital using this technique because of vaginal vault prolapse. These women had undergone hysterectomies (10 abdominal; 2 vaginal) between 5 and 22 years previously (mean, 12 years). After pre-laparoscopic preparation, a 10-mm trocar with a 10-mm zero-degree telescope was placed into the Retzius space. Using a direct air-distended method with a 20 mmHg insufflation pressure, Retzius and para-rectal spaces were created. The sacrospinous ligament could be easily identified and confirmed. A permanent suture was then inserted from the sacrospinous ligament to the vaginal vault to ensure that there was no space in between.
  
  
  RESULTS
  This procedure was followed for all 12 patients. There were no major complications during surgery. Eleven women had no recurrence of vaginal vault prolapse during a follow-up period of 1 to 3 years (mean, 2.2 years). One patient developed recurrent vaginal vault prolapse; however, she subsequently underwent a successful colposacropexy by laparoscopy 23 months after the initial surgery.
  
  
  CONCLUSIONS
  We modified the traditional sacrospinous fixation laparoscopically, following principles to restore the correct anatomic position of the vault. Laparoscopic extraperitoneal sacrospinous suspension can eliminate the procedure of opening and closing the peritoneum and avoid interference with the intestine during surgery. It can be used as an alternative to traditional genital suspension surgeries.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, R.O.C. chyilong@ms21.hinet.net
authors.forename: C L
authors.initials: CL
authors.lastname: Lee
authors.forename: C J
authors.initials: CJ
authors.lastname: Wang
authors.forename: C F
authors.initials: CF
authors.lastname: Yen
authors.forename: Y K
authors.initials: YK
authors.lastname: Soong
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D014596:Uterine Prolapse / Q000601:surgery*