57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex)

Name of the Procedure:

Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
Common Names: Laparoscopic Colpopexy, Vaginal Apex Suspension

Summary

Laparoscopic colpopexy is a minimally invasive surgical procedure designed to correct pelvic organ prolapse by attaching the vaginal apex to the sacrum using a laparoscope. This suspension helps to restore normal anatomy and function.

Purpose

The procedure addresses pelvic organ prolapse, specifically uterine prolapse or vaginal vault prolapse post-hysterectomy. The goal is to provide support to the vaginal apex, alleviate symptoms like pelvic pressure, bladder issues, and improve overall quality of life.

Indications

• Symptoms of pelvic organ prolapse such as vaginal bulging, pelvic pressure, lower back pain, urinary incontinence, or dyspareunia.
• Patients with uterine prolapse or vaginal vault prolapse.
• Candidates for surgery who have not responded to conservative treatments such as pessaries or pelvic floor therapy.

Preparation

• Patients may be instructed to fast for 8 hours before the procedure.
• Medications may need to be adjusted or stopped, especially blood thinners.
• Pre-procedure diagnostic tests may include pelvic exams, ultrasound, or MRI.
• Bowel preparation might be required as instructed by the healthcare provider.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted to visualize internal structures.
4. Additional small instruments are inserted through other incisions.
5. The vaginal apex is attached to the sacrum using mesh or sutures to provide support.
6. The instruments are removed and incisions are closed.

Tools and Equipment:

• Laparoscope
• Surgical instruments for cutting and suturing
• Surgical mesh (if used)

Duration

The procedure typically takes about 2 to 3 hours.

Setting

It is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically a gynecologist or urogynecologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Injury to surrounding organs (bladder, bowel)
• Mesh complications (erosion, exposure)
• Pelvic pain
• Recurrence of prolapse

Benefits

• Relief of prolapse symptoms
• Improvement in urinary and bowel function
• Enhanced quality of life
• Minimally invasive with shorter recovery time compared to open surgery

Recovery

• Most patients can go home the same day or after an overnight stay.
• Pain management includes oral pain relievers.
• Avoid heavy lifting and strenuous activity for 6 to 8 weeks.
• Follow-up appointments are necessary to monitor healing.
• Many return to normal activities within 4 to 6 weeks.

Alternatives

• Non-surgical options like pelvic floor physical therapy or pessary use.
• Open abdominal colpopexy or vaginal surgical procedures.
• Pros of alternatives include avoiding surgery (for conservative measures); cons include lower efficacy in severe cases.

Patient Experience

• During the procedure: Patients will be under general anesthesia and will not feel anything.
• After the procedure: Some pain and discomfort at the incision sites, managed with medication.
• Typical symptoms include mild cramping and bloating.
• Most experience significant symptom relief within a few weeks.