Editorial board editor-in-chief

Keywords:
colpopexy, laparoscopy, organ prolapse, vagina fault
Pelvic organ prolapse may occur in up to 50% of parous women. 
An estimated three out of four women with prolapse have a rec-
tocele. This problem is associated with a 11% lifetime risk of 
requiring major surgery [1]. Laparoscopic approach and tech
-
niques have been applied to most abdominal route surgical 
procedures for treatment of urinary incontinence and pelvic organ 
prolapse. As was irst reported by Nezhat et al., the application 
of laparoscopic abdominal sacral colopexy has increased [2]. 
The recurrence rate reaching 30% following traditional surgi
-
cal repair of vaginal prolapse has consequently led to more 
frequent use of permanent mesh and grafts. The use of mesh 
for sacrocolpopexy for correcting apical vaginal prolapse has 
a reported success rate from 78 to 100% and median reopera
-
tion rate for prolapse of 4.4%. Nygaard et al. reported a mean 
rate of mesh erosion of 3.4% [3]. The study made by Culligan 
et al. reported a 27% mesh erosion rate when sacrocolpopexy 
was performed with hysterectomy, compared with 1.3% when 
concomitant hysterectomy was not performed [4].
Cundiff and Fenner reviewed and summarized outcomes after 
posterior colporrhaphy, site-speciic repair, transanal repair, and 
rectocele repair with graft materials [5]. Anatomic cure ranged 
from 76% to 96% for posterior colporrhaphy and from 56% to 
100% for site-speciic defect repair. For example, a paravaginal 
defect repair (PvDR) involves repair of discrete defects in the 
anterior vaginal endopelvic fascia. The success of the abdominal 
paravaginal repair for correcting cystocele ranges between 76 
and 97% [6].
Common indications for the graft implantation include: post 
partum patients, after previous failed surgery due to organ pro-
lapse and for severe pelvic organ prolapse [7]. On the other hand, 
according to the International Urogynecological Association, 
contraindications such as host conditions may compromise the 

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T
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Laparoscopic colpopexy technique…
vascular supply to the pelvic loor. These include history of pelvic 
radiation, poorly controlled diabetes, severe vaginal atrophy, 
systemic steroid use, and heavy tobacco use [8]. 
Materials and methods
The objective of this study was to assess the safety and feasibility 
of a laparoscopic approach for vaginal vault defect, using mesh 
placed along the round ligaments and sutured into the fascia of 
the rectus muscle. 
We analyzed 28 patients diagnosed with symptomatic vaginal 
vault prolapse. All the women underwent a standardized pelvic 
examination to evaluate the stage of genital prolapse. This was 
done through the use of the Pelvic Organ Prolapse Quantiica
-
tion (POPQ), which is designed to assess the anterior vaginal 
wall prolapse (point Ba), uterine or vaginal vault prolapse (point 
C) and posterior vaginal wall prolapse (point Bp) on maximum 
valsalva effort. One of the patients had urodynamic evaluation 
due to urinary incontinence [9].
All the patients in the study (except Group C) had history of 
vaginal bleeding due to uterine ibroids or menopausal hormone 
disorders. To rule out endometrial and cervical cancer among 
Groups A and B, endometrial biopsy and Pap smears were 
conducted respectively. There were no pathologic indings. 
Among patients younger then 50 years of age without ab-
normalities on pelvic ultrasound, adnexae were left in place. 
Preoperative bowel preparation was done in the evening 
before surgery. For prevention of deep venous thrombosis 4000U/
daily s.q. of low weight heparinwas given, while cefuroxim (3g/
daily i.v.) was used prophylactically against infection.
The patient was placed in a modiied dorsolithotomy posi
-
tion with legs semilexed and apart, and with arms by her side. 
A Foley catheter was introduced into the bladder and the patient 
underwent general anesthesia and endotracheal intubation.
The following technique was applicable to patients with mild 
to moderate vaginal vault prolapse. The patient was placed in 
a supine position and prepared and draped using a sterile tech-
nique. Laparoscopic approach for colpopexy can be performed 
with uterine extirpation or among patients who have a history of 
hysterectomy. Three incisions were made using trocars; one 
10mm cut at the umbilical apex, another two 5mm cut bilaterally 
medial and inally just above the ileac crest. 
We evaluated three groups of patients. Group A, which had 
colpopexy performed with LSH (laparoscopic supracervical hys-
terectomy), group B with TLH (total laparoscopic hysterectomy) 
and group C patients who have had a previous hysterectomy. 
We used monoilament polypropylene mesh (Prolene, Ethi
-
con, Johnson & Johnson, UK). 
A larger 30cm x 30cm mesh was reduced to dimensions of 
200 mm x 20mm, followed by a 150mm lengthwise cut at the 
centre as shown in Figure 1.