title: LESS sacrocolpopexy: step by step of a simplified knotless technique.
abstract: BACKGROUND
  Pelvic organ prolapse is an ordinary disease with around 200.000 surgeries performed annually in the US to treat this condition. The surgical treatment for complete vaginal vault prolapse after hysterectomy involves abdominal or vaginal sacrocolpopexy. The purpose of this video is to demonstrate the steps of a laparoendoscopic single-site surgery (LESS) sacrocolpopexy performed by a simplified knotless technique.
  
  
  METHODS
  A 52 year-old female submitted a total hysterectomy five years ago due to miomatosis who developed vault prolapse and urinary incontinence after surgery. She was treated by transumbilical LESS cutaneous retractor and a surgical glove attached to three trocars through a 3.5 cm umbilical incision. Patient was positioned in lithotomy, the Y-shape polypropylene mesh was passed through the trocar. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix using 3 continuous sutures held in extremities by polymeric clips. The last helical suture was fixed by polymeric clips to the sacral periosteum from the promontory to achieve good vaginal positioning without tension. The posterior peritoneum was closed over the mesh.
  
  
  RESULTS
  The operative time was 150 minutes, blood loss of approximately 100 mL and the patient was discharged after 18 hours with no immediate complications and a 3 months follow-up free of vault prolapse and urinary incontinence until now.
  
  
  CONCLUSIONS
  LESS sacrocolpopexy performed with conventional instruments is feasible and a safe procedure reproducing surgical steps of conventional laparoscopic or robotic surgery.
authors.affiliation: Department of Urology, ABC Medical School, 821 Principe de Gales Avenue, Santo André, SP, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Chicoli
authors.forename: Renato M M
authors.initials: RM
authors.lastname: Costa
authors.forename: Alexandre Stievano
authors.initials: AS
authors.lastname: Carlos
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bezerra
authors.forename: Luiz F F
authors.initials: LF
authors.lastname: Longuino
authors.forename: Eduardo S
authors.initials: ES
authors.lastname: Starling
authors.forename: André L F
authors.initials: AL
authors.lastname: Tome
authors.forename: Antonio C L
authors.initials: AC
authors.lastname: Pompeo
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome