Pelvic organ prolapse is a prevalent disorder among women, significantly impairing their quality of life. Achieving apical support is essential for effective management. Sacrocolpopexy and pectopexy are established treatments for apical and multicompartment prolapse, demanding advanced suturing and dissection abilities. These techniques, however, come with risks, including mesh exposure, dyspareunia, ileus, new onset of bowel dysfunction, and potential for intraoperative damage to the bladder or intestines.
This video aims to introduce a demonstration of a novel, minimally invasive approach to rectify apical and concurrent apical and anterior vaginal wall prolapses.

We describe a streamlined laparoscopic pectopexy technique utilizing two ports and an extracorporeal slippage knot, accompanied by detailed procedural steps.

Pectopexy Procedure (10 steps):

1. The peritoneum is incised to separate the bladder and reveal the cervix, beginning along the right round ligament.
2. This incision is extended towards the right triangular space, bordered by the round ligament and the medial umbilical ligament.
3. Identification of the pectineal ligament occurs through an incision in fatty tissue aligned with the obliterated umbilical artery, thus safeguarding it from the external iliac vessels.
4. A similar peritoneal incision is made on the left side, targeting the triangular area adjacent to the round ligament and medial umbilical ligament.
5. The left pectineal ligament is dissected.
6. The dissection proceeds up to the bladder neck.
7. The middle portion of the mesh is affixed to the cervix and anterior vaginal wall with 6 to 10 sutures using an extracorporeal knotting method.
8. The mesh's end is secured to the right pectineal ligament using non-absorbable polypropylene and Ethibond sutures, applying an extracorporeal slipping knot.
9. A similar technique is used to attach the mesh end to the left pectineal ligament.
10. The mesh is covered with peritoneum using absorbable sutures.

Mesh fixation to the cervix and anterior vaginal wall averages 15 minutes, with an equal duration for both pectineal ligaments' anchoring. The typical hospital stay was one day, with no intraoperative or early postoperative complications reported. No instances of mesh erosion or long-term issues were observed. At one year, no recurrence was noted, with the median postoperative point C being -8 cm.

The described pectopexy approach, featuring an innovative extracorporeal knot method, offers a viable, minimally invasive solution for primarily apical or multicompartment defects. This approach ensures short surgery times and robust anatomical support.

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Yang Y, Li Z, Si K, Dai Q, Qiao Y, Li D, Zhang L, Wu F, He J, Wu G. Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol. 2023 Oct;30(10):833-840.e2. doi: 10.1016/j.jmig.2023.06.011. Epub 2023 Jun 25. PMID: 37369345.