Standard practice of presacral exposure during transvaginal natural orifice transluminal endoscopic surgery for sacrocolpopexy
Zhiying Lu, K Hua, Y Chen, Changchen Hu
Abstract
We describe the standard practice of presacral exposure during transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrocolpopexy in women with uterine prolapse. In this video, we demonstrate the key techniques: identifying the right hypogastric nerve (rHN) before opening the pelvic peritoneum; removing the fat and loose connective tissue along the rHN to expose the presacral fascia; incising the presacral fascia to reach the presacral space to expose the middle sacral vasculature and the anterior longitudinal ligament (ALL) of the first sacral vertebra (S1) below the promontory; attaching the mesh to the ALL to avoid vessel injury; and completing the peritonealisation.
Topics & Concepts
MedicinePromontoryFasciaAnterior longitudinal ligamentSurgeryNatural orifice transluminal endoscopic surgeryAnatomyHypogastric nerveSacrumLaparoscopyStimulationHistoryArchaeologyOssificationInternal medicinePelvic floor disorders treatmentsPelvic and Acetabular InjuriesHernia repair and management