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Kim: Robotic sacrocolpopexy with nerve sparing dissection technique
For apical uterine prolapse and multi-compartment prolapse, sacrocolpopexy is considered the most effective treatment [1]. However, de novo bladder, bowel and sexual dysfunctions have been reported after sacrocolpexy and may be caused by intraoperative damage of the pelvic autonomous nerves [2-4].
The superior hypogastric plexus is situated at the level of the aortic bifurcation and include sympathetic fibers from sympathetic trunk. Then superior hypogastric plexus (SHP) spreads out to form the bilateral inferior hypogastric plexus (IHP), which take up parasympathetic fibers from the splanchnic and inferior mesenteric nerves [5,6]. During robotic sacrocolpopexy, dissection of the presacral space in the sacral promontory and right pelvic side wall alongside the uterosacral ligament and crossing to the rectovaginal space can damage fibers of the superior and IHP. This results in postoperative side effects such as incomplete voiding, defecatory dysfunction, pain, and sensory problems [7,8].
This video demonstrates our robotic sacrocolpopexy with nerve sparing dissection technique. The patient is a 62-year-old woman with symptomatic stage III apical uterine prolapse. The steps of technique include opening the peritoneum at the level of the sacral promontory, identification of the fibers of the SHP and right hypogastric nerve, displacement of the nerve fibers to the left side, deep posterior dissection to expose the longitudinal ligament of S1 vertebral body. Then we extended the peritoneal dissection superficially along the lateral side of right uterosacral ligament to the rectovaginal space. After attachment of the mesh to the vagina and sacrum, the surgery is completed after peritonealization. This nerve sparing dissection technique is feasible and can be considered by surgeons who perform robotic sacrocolpopexy.

Video related to this article

The video related to this article can be found online at 10.36637/grs.2022.00136.


Conflict of interest

No potential conflict of interest relevant to this article was reported.


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