Laparoscopic lateral suspension with mesh for the management of pelvic organ prolapse: an educative video (case report)

Laparoscopic sacrocolpopexy (SCP) using a mesh has been the treatment of choice for pelvic organ prolapse for more than 20 years. However, the potential surgical difficulties associated with the promontory dissection have prompted reflection on surgical alternatives that completely avoid the promontory. Laparoscopic lateral suspension (LLS) is a promising option that gives satisfactory anatomical and functional results. The originality of LLS with mesh is the subperitoneal tunnel of the lateral long arms of the T-shaped mesh through the lateral abdominal wall, leaving the skin above the iliac crest. This suspension prevents potential major risks of injury to the blood vessels, nerves, or bowel, and provides symmetrical lateral tension-free suspension in an anatomical vaginal axis. The indications for LLS are anterior pelvic organ prolapse and apical descent. LLS can be considered when the access of the promontory is difficult; for instance, in the presence of severe adhesions, sigmoid megacolon, or a low-positioned left common iliac vein that partially covers the promontory. LLS is also a practical alternative technique for surgeons with only moderate experience in dissecting the promontory area. LLS represents a simple, effective and reproducible technique that rarely causes complications. In this article, the different surgical steps of the procedure are described, providing practical tips for a successful surgery.