岬角前面に血管が走行し腹腔鏡下仙骨腟固定術が困難な骨盤臓器脱の症例に対して腹腔鏡下外側固定術を施行した１例

Laparoscopic sacrocolpopexy (LSC) is becoming a popular surgical method for patients with pelvic organ prolapse. It is associated with a lower rate of recurrence and higher rate of patient satisfaction. Dissecting the peritoneum on the promontory of the sacrum to expose the anterior longitudinal ligament is an essential part of this surgery. However, there are some cases in which we cannot perform this procedure due to anatomical anomalies. Laparoscopic lateral suspension (LLS) is another surgical procedure for patients with pelvic organ prolapse. It involves the anchoring and suspension of a mesh, without exposing the longitudinal ligament at the promontory of the sacrum. LSC was planned for a 74-year-old woman (gravida 2, para 2) with stage III pelvic organ prolapse. Preoperative magnetic resonance imaging showed that her right common iliac artery ran in front of the promontory of the sacrum, and it considered difficult to expose the anterior longitudinal ligament. The surgical method was changed from LSC to LLS with barbed suture for posterior colporrhaphy using V-Loc. The operation time was 5 hours and 37 minutes; there was little blood loss. She had an uneventful postoperative course with no recurrence at nine months after surgery. LLS with barbed suture for posterior colporrhaphy can be an effective alternative method when it is difficult to dissect the peritoneum on the promontory of the sacrum to expose the anterior longitudinal ligament in LSC.