title: Laparoscopic sacrocolpopexy: demonstration of a nerve-sparing technique.
abstract: Laparoscopic sacrocolpopexy is a well-established technique to treat apical vaginal prolapse. De novo micturition disorders, pelvic pain, and defecation disorders have been reported and may be due to intraoperative compromise of the superior hypogastric plexus. The video demonstrates our technique for nerve-sparing laparoscopic sacrocolpopexy. The patient is a 62-year-old woman with symptomatic stage III posthysterectomy vaginal vault prolapse. Key steps of the procedure are opening the peritoneum at the level of the promontory, identification of the fibers of the superior hypogastric plexus, deep anterior and posterior dissection with attachment of the mesh to the vagina, displacement of the nerve fibers to the left side during suturing of the mesh to the longitudinal ligament, and complete peritonealization. This technique of the identification and protection of relevant nerve structures appears to be reproducible and can be considered by surgeons who perform laparoscopic sacrocolpopexy.
authors.affiliation: Department of Obstetrics and Gynecology, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: dimitri.sarlos@ksa.ch.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Sarlos
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aigmueller
authors.affiliation: Department of Obstetrics and Gynecology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Heimo
authors.initials: H
authors.lastname: Magg
authors.affiliation: Department of Obstetrics and Gynecology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Schaer
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007001:Hypogastric Plexus; D010535:Laparoscopy; D008875:Middle Aged; D059351:Organ Sparing Treatments; D012447:Sacrum / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery
keywords: hypogastric nerve; laparoscopic sacrocolpopexy; nerve sparing; prolapse surgery