Nerve-sparing laparoscopic colposacropexy using a percutaneous surgical system: a case report.

STUDY OBJECTIVE: To evaluate the feasibility, efficacy and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2,9 mm PercuvanceTM Percutaneous Surgical System (PSS) (The PercuvanceTM System, Teleflex Inc., USA). DESIGN: Step-by-step video demonstration of the surgical technique. The Internal Department Committee approved this study. The patient was adequately informed about the possible risks and benefits of this experimental technique and a written consent agreeing to undergo the described procedure was signed. SETTING: Pelvic organ prolapse is a condition affecting up to 50% of multiparous women. It may be considered a real public health problem that can have an important impact on general health-related quality of life. A conservative and/or medical treatment may be considered only for women with mild degree of prolapse, women with a reproductive desire or women unable to undergo surgery. In the remaining cases, surgery seems to be the most effective treatment. Surgical approach may be abdominal (colposacropexy by laparotomy, laparoscopy or robot-assisted) or vaginal (autologous, or prothesic reinforcement). The aims of the surgical procedures include not only the anatomical correction of the prolapse but also the improvement of patient's quality of life and prolapse symptoms relief, guaranteeing a normal bladder, bowel and sexual functions and avoiding iatrogenic dysfunctional symptoms. At present, the laparoscopic technique of sacral colpopexy offers a number of important advantages including an excellent visualization of the pelvis, reduction in adhesions formation, decreased post-operative pain and recovery with a success rate reported to be 90-96% with a mesh erosion rate of 1-8%. INTERVENTION: Nerve-sparing laparoscopic colposacropexy with positioning of two polypropylene titanized meshes and concomitant subtotal hysterectomy and salpingo-oophorectomy entirely performed with 2,9 mm PSS. CONCLUSION: This case-report is the first reporting a nerve-sparing laparoscopic colposacropexy performed with 2,9 mm PSS. The major advance of this technique is the possibility of performing a major gynaecology surgery with a scarless approach, which results in fewer traumas for the patient in the postoperative time. The use of these instruments does not increase the operation time or the rate early or late complications, most of all prolapse recurrence. Considering that this is the first case report in literature, more clinical data are needed to confirm these findings.