This video demonstrates Sacrocolpopexy in patients with severe adhesion performed by Dr R K Mishra at World Laparoscopy Hospital. Pelvic organ prolapse (POP) regards an increasing number of women. The gold standard procedure for the POP is laparoscopic sacrocolpopexy. Adhesions often occur after pelvic surgery, with a lower incidence after laparoscopy. We present a laparoscopic sacrocolpopexy in a patient with severe pelvic adhesions.

Laparoscopic surgical procedures for the treatment of POP are effective and safe techniques and prevent the formation of adhesions, but complex adhesions cases can increase the difficulty of surgical procedures.

Sacrocolpopexy is considered the gold standard surgical procedure for apical pelvic organ prolapse, especially in patients with vault prolapse following hysterectomy. Performing sacrocolpopexy in patients with severe intra-abdominal adhesions presents a significant surgical challenge and requires advanced laparoscopic expertise, careful preoperative planning, and precise surgical execution. At World Laparoscopy Hospital, located in Gurugram, such complex minimally invasive procedures are performed using advanced laparoscopic techniques and standardized surgical protocols.

Severe adhesions usually develop due to previous abdominal or pelvic surgeries, endometriosis, pelvic inflammatory disease, or prior infections. Adhesions distort normal pelvic anatomy, obscure tissue planes, increase the risk of bowel or bladder injury, and prolong operative time. Therefore, preoperative imaging such as MRI or contrast CT scan may help in surgical planning. Detailed patient counseling is also essential, as these cases may carry a higher risk of conversion to open surgery and postoperative complications.

The procedure begins with careful entry into the abdomen using safe access techniques, often through Palmer’s point or open (Hasson) technique, to minimize the risk of bowel injury. Extensive adhesiolysis is performed meticulously using sharp and energy-based dissection, ensuring preservation of vital structures such as bowel loops, ureters, and bladder. Adequate exposure of the sacral promontory and vaginal vault is essential before mesh placement.

Once adhesiolysis is completed, the vaginal vault is dissected and prepared for mesh fixation. A Y-shaped synthetic mesh is commonly used, with one arm attached to the anterior vaginal wall and the other to the posterior vaginal wall. The proximal end of the mesh is then fixed securely to the anterior longitudinal ligament over the sacral promontory. Peritoneal closure over the mesh is performed to reduce the risk of mesh erosion and bowel adhesions.

In patients with severe adhesions, operative time may be longer, and blood loss may be slightly higher than routine sacrocolpopexy cases. However, with advanced laparoscopic skills, magnified visualization, and modern energy devices, surgeons can achieve excellent outcomes with minimal morbidity. Postoperative recovery is usually fast, with early ambulation, less pain, shorter hospital stay, and early return to normal activities.

The success of sacrocolpopexy in severe adhesion cases depends heavily on surgeon experience, patient selection, and intraoperative decision-making. At World Laparoscopy Hospital, surgeons are trained to handle such complex cases using evidence-based laparoscopic techniques, ensuring high success rates and improved quality of life for patients suffering from advanced pelvic organ prolapse.

In conclusion, laparoscopic sacrocolpopexy in patients with severe adhesions is a technically demanding yet highly rewarding procedure. With proper surgical expertise, advanced laparoscopic infrastructure, and structured training, it can be performed safely and effectively, offering durable anatomical correction and excellent functional outcomes.

For more information: https://www.laparoscopyhospital.com/