- Email: [email protected]
2671 Lefort Colpocleisis
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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ureteric injuries. One patient had ongoing fistulous drainage per vaginal at the time of case settlement. Most litigated cases were dismissed. Conclusion: GU and GI fistulas are rare but morbid entities, which most often manifest after missed bladder or bowel injuries, post benign gynecological surgeries. Early detection and recognition of GI and GU injuries may be key for secondary prevention of fistula formation.
Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2Obstetrics and Gynecology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada; 3University of Toronto, Faculty of Medicine, Toronto, ON, Canada *Corresponding author.
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM)
Study Objective: To determine if there is any difference in outcomes between estrogen, bupivacaine and saline-soaked vaginal packing, in patients following pelvic floor reconstructive surgery (PFRS). The primary outcome is post-operative pain, as rated by patients using a visual analog scale (VAS) 2 and 6 hours post-surgery and on the morning of post-operative day1 (POD#1). Secondary outcomes include: intra-operative estimated blood loss (EBL), change in hemoglobin, pain medication use, urinary retention, and length of stay (LOS) in hospital. Design: Prospective cohort study. Setting: Tertiary academic care center. Patients or Participants: Patients undergoing PFRS for pelvic organ prolapse and/or stress urinary incontinence by four trained urogynecologists at an academic center. 142 patients have been enrolled. Interventions: Women undergoing vaginal surgery received vaginal packing that was soaked with saline, 0.25% Bupivacaine or conjugated estrogen vaginal cream, according to physician preference. Measurements and Main Results: The study population included 142 patients (saline: n=40; bupivacaine: n=47; estrogen: n=55). Results of ANOVA showed no significant differences between the three treatment methods for post-operative pain scores (at 2 hours and 6 hours post-surgery as well as morning of POD#1). The average VAS (2hours) was 2.24, 2.30 and 2.66 and among patients receiving saline, Bupivacaine and estrogen respectively (p=0.4656). There were no significant differences between any of the three treatment methods in VAS pain scores at 6 hours (p=0.2181), and POD#1 (p=0.2832). No significant difference was found with EBL between the three groups (p=0.8914). Conclusion: This study did not find a difference between the use of saline, bupivacaine and estrogen cream with vaginal packing after pelvic floor reconstructive surgery on post-operative VAS pain scores, EBL, LOS or urinary retention. Saline soaked packing is an equivalent, but less expensive, alternative to estrogen or bupivacaine vaginal packing − and could replace estrogen-soaked packing in those who have contraindications to estrogen use.
1:10 PM: STATION K 1395 Treatment of Vaginal Mesh Exposure with Platelet Rich Plasma and CO2 Laser EI3. 1Flinders Behnia-Willison F,1,* Nguyen TTT,1 Lam AM,2 Seman Endogynaecology, Flinders Medical Centre, Adelaide, SA, Australia; 2 Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia; 3 Flinders Medical Centre, Bedford park, SA, Australia *Corresponding author. Study Objective: To present our experience of treating vaginal mesh exposure with various modalities including Platelet Rich Plasma (PRP) and Co2 Laser Design: Prospective cohort study Setting: Patients referred to a gynecologist with a special interest in urogynaecology who worked at Adelaide, Sydney, and Geelong Patients or Participants: 34 patients with symptomatic mesh exposure between 2009 and 2018 Interventions: All patients were offered treatment with vaginal topical estrogen. Patients who continued to be symptomatic were treated with either PRP alone or surgical excision and PRP injection. These patients have been followed up on an annual basis since the time of treatment. Measurements and Main Results: 5 women declined topical estrogen due to personal or family history of Breast cancer
4 patients received PRP and had complete re-epithelialization of the vaginal mucosa
1 patient received combined PRP and laser 29 Women used vaginal estrogen
6 women responded to long-term (3-6 months) E2 treatment and needed no further treatment.
9 were treated with laser and PRP alone
14 women required surgery 4 women did not respond to E2 treatment and did not wish to have surgery; they received PRP and had complete re-epithelialization of the vaginal mucosa. 14 women underwent surgical excision and primary closure with PRP injection at the time
10 had laser and PRP
9 of the 14 women needed no further surgery after six months. 3 women had repeat surgery for further mesh exposure. Conclusion: The treatment of symptomatic vaginal mesh exposure might be complex in some cases. In recurrent cases, multi-modal treatment may be required. PRP and PRP autologous graft may benefit women whose mesh exposure is associated with severe atrophy or where large areas of vaginal epithelium need removal. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION L 2234 Comparing Pain Levels and Blood Loss Following Pelvic Floor Reconstructive Surgery Between Vaginal Packing Soaked with Either Estrogen, Bupivacaine or Saline Jolliffe CJ,1,* Michael A,2 Myrox P,3 Li X,3 Abraham T,2 Kung RC,1 Gagnon LH,1 Bodley J,1 Lee PE1. 1Division of Urogynecology,
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION M 2671 Lefort Colpocleisis Raju R,1,* Occhino JA,1,2 Linder BJ1,2. 1Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; 2Division of Urogynecology, Mayo Clinic, Rochester, MN *Corresponding author. Video Objective: To present the technical considerations and pearls to performing a LeFort Colpocleisis. Setting: Patient is a 76 year old female with history of a vaginal bulge for the past 6 months and a failed pessary trial. She also reports urge-predominant mixed urinary incontinence with worsening stress urinary incontinence with reduction of the pelvic organ prolapse. She is not sexually active and does not plan on any future sexual activity. She does not have any abnormal pap smears and denies postmenopausal bleeding. Her past medical history is significant for multiple comorbid conditions including cardiac issues with a pacemaker, chronic kidney disease, hypertension and diabetes. Her past surgical history is complicated by aortic valve replacement (porcine valve), tubal ligation and a left total knee replacement. On exam she has a Stage IV uterine, anterior and posterior compartment prolapse with positive occult stress urinary incontinence. Urodynamic studies reveal stress urinary incontinence, no detrusor overactivity and an elevated post void residual (125 ml after
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
241 ml void). She was counseled regarding management options including conservative options (observation or repeat pessary trial), restorative procedures (vaginal vault suspension or sacrocolpopexy), or an obliterative procedure such as a LeFort Colpocleisis. Interventions: The patient opted for a LeFort Colpocleisis. She underwent a Dilation and curettage, a LeFort colpocleisis, Posterior colpoperineorrhaphy, Cystoscopy and a Midurethral Sling Placement. Conclusion: The technical considerations for performing a LeFort Colpocleisis include ruling out malignancy prior to surgery, adequate lateral channels for uterine drainage, the use of lidocaine with epinephrine, closure in multiple layers with excellent hemostasis and an aggressive posterior colpoperineorrhaphy.
Endoscopy Unit, Clınica del Prado, Medellın, Colombia; 3Obstetric and Gynecology Journal, CES University, Medellin, Colombia *Corresponding author.
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION N 1406 Same-Day Discharge Following Vaginal Hysterectomy with Pelvic Floor Reconstruction: A Pilot Study Liu LA,1,* Yi J,2 Wasson MN3. 1GYN, Lenox Hill Hospital, New York, NY; 2 Mayo Clinic, Phoenix; 3Mayo Clinic Arizona, Phoenix, AZ *Corresponding author. Study Objective: Determine safety and feasibility of same-day discharge in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design: Prospective cohort pilot study. Setting: Single academic medical center. Patients or Participants: Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions: Same-day discharge or overnight hospitalization following surgery. Measurements and Main Results: A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women that were planned for overnight hospitalization. The intervention group had 36 women that were planned for same-day discharge. In the intervention group, 63.9% of patients (n=23) were successfully discharged home and 36.1% (n=13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness) (n=9; 69%), uncontrolled pain (n=1, 7.7%), fever (n=1, 7.7%), anemia (n=2, 15.4%), with return to operating room for hematoma evacuation (n=1; 7.7%). Voiding trial was passed on first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = 0.011). There were no significant differences in the number of emergency department visits (p=0.677) or unplanned office visits (p=0.193) between the control and intervention groups. Conclusion: Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same-day did not require a higher volume of emergency department or office evaluations. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION O 1820 Resection of Uterus, Fallopian Tubes and Gonades by Laparoscopy in Patient with Sexual Ambiguity noz MA3. 1Gynecological Gomez-Correa SM,1,* De Los Rios JF,2 Mu~ Endoscopy Unit, Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) AAGL, Clinica del Prado, Medellin, Colombia; 2Gynecological
Video Objective: Describe a clinical case of a patient with sexual ambiguity and his laparoscopic surgical treatment. Setting: 33-year-old patient with a sexual ambiguity and male identification who required resection of gonads and atrophic organs. was performed in Prado Clinic in Medellin, Colombia. Interventions: Laparoscopic hysterectomy plus gonadal resection was performed in a patient with a male phenotype in whom uterine manipulator placement wasn’t possible. Conclusion: In this moment, focus on sexual ambiguity has been changed. Now there is a greater emphasis on a conservative approach and the delay of irreversible surgery until adulthood. That new approach allows the individualization of the patient and makes surgical decision once a gender identity is presented. Laparoscopic surgery has been found to be a tool for the adequate treatment that allows a complete visualization of the atrophic organs and gonads. Generating almost imperceptible scars in the long term and preventing possible malignant transformation in the future. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION P 1201 Laparoscoic Supracervical Hysterectomy and Sacrocervicopexy Using Flexdex’s Platform Technology with Extraction of The Surgical Specimen by the Posterior Colpotomy for the Treatment of Uterine Prolapse Souza CA,1,* Pazello RT,2 Hajar F3. 1School of Minimally Invasive Surgery, Instituto Crispi, Rio de Janeiro, Brazil; 2Servi¸c o de cirurgia laparoscopica, Ophera, Curitiba Paran a, Brazil; 3Universidade Federal do Paran a, Curitiba, Brazil *Corresponding author. Video Objective: Demonstrate the functionality and capabilities of the FlexDex platform in a high technical complexity procedure, a videolaproscopy supracervical hysterectomy with cervicosacropexy. Setting: A 76-years-old patient with uterine prolapse (POP-Q stage III) was selected for laparoscopic treatment with the aid of the FlexDex platform. Interventions: Initially, the supracervical hysterectomy was performed, followed by the cervix closure and the opening of the peritoneum at the level of the promontory − identifying the hypogastric nerve, lateralizing it with the endopelvic fascia and medializing the mesosigmoid fascia for the development of the pararectal space. Thus, allowing continuity to rectovaginal space and preparing the mesh bed. Next, a lightweight, macroporous, Yshaped polypropylene mesh was fixated to the cervix stump − being assisted by the FlexDex platform, which enables the suturing to be made backhanded in a angulated topography. Then, the anatomical landmarks were identified before proceeding to the sacropexy - middle sacral vessels, sacral promontory, anterior longitudinal ligament, aortic bifurcation, inferior vena cava, right common iliac vessels and right ureter. After the mesh fixation to the promontory, the burial of the mesh was achieved with the closure of the peritoneum with a continuous suture. All the suturing during the surgery was accomplished utilizing only one trocar arrangement, enabled by the virtual center of rotation of the FlexDex platform. The surgical specimen was removed by posterior colpotomy, avoiding its morcellation. Once again, the closure of the posterior vaginal wall was facilitated by the endless rotation of the platform, enabling the ideal movement of the needle, following its curvature. Conclusion: The FlexDex platform allows similar amplitude and intuitive wrist movement of the surgeon during complex procedures such as the one here presented − being a cost-effective alternative to the robot technology in countries where it is not readily available.
S213
ureteric injuries. One patient had ongoing fistulous drainage per vaginal at the time of case settlement. Most litigated cases were dismissed. Conclusion: GU and GI fistulas are rare but morbid entities, which most often manifest after missed bladder or bowel injuries, post benign gynecological surgeries. Early detection and recognition of GI and GU injuries may be key for secondary prevention of fistula formation.
Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2Obstetrics and Gynecology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada; 3University of Toronto, Faculty of Medicine, Toronto, ON, Canada *Corresponding author.
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM)
Study Objective: To determine if there is any difference in outcomes between estrogen, bupivacaine and saline-soaked vaginal packing, in patients following pelvic floor reconstructive surgery (PFRS). The primary outcome is post-operative pain, as rated by patients using a visual analog scale (VAS) 2 and 6 hours post-surgery and on the morning of post-operative day1 (POD#1). Secondary outcomes include: intra-operative estimated blood loss (EBL), change in hemoglobin, pain medication use, urinary retention, and length of stay (LOS) in hospital. Design: Prospective cohort study. Setting: Tertiary academic care center. Patients or Participants: Patients undergoing PFRS for pelvic organ prolapse and/or stress urinary incontinence by four trained urogynecologists at an academic center. 142 patients have been enrolled. Interventions: Women undergoing vaginal surgery received vaginal packing that was soaked with saline, 0.25% Bupivacaine or conjugated estrogen vaginal cream, according to physician preference. Measurements and Main Results: The study population included 142 patients (saline: n=40; bupivacaine: n=47; estrogen: n=55). Results of ANOVA showed no significant differences between the three treatment methods for post-operative pain scores (at 2 hours and 6 hours post-surgery as well as morning of POD#1). The average VAS (2hours) was 2.24, 2.30 and 2.66 and among patients receiving saline, Bupivacaine and estrogen respectively (p=0.4656). There were no significant differences between any of the three treatment methods in VAS pain scores at 6 hours (p=0.2181), and POD#1 (p=0.2832). No significant difference was found with EBL between the three groups (p=0.8914). Conclusion: This study did not find a difference between the use of saline, bupivacaine and estrogen cream with vaginal packing after pelvic floor reconstructive surgery on post-operative VAS pain scores, EBL, LOS or urinary retention. Saline soaked packing is an equivalent, but less expensive, alternative to estrogen or bupivacaine vaginal packing − and could replace estrogen-soaked packing in those who have contraindications to estrogen use.
1:10 PM: STATION K 1395 Treatment of Vaginal Mesh Exposure with Platelet Rich Plasma and CO2 Laser EI3. 1Flinders Behnia-Willison F,1,* Nguyen TTT,1 Lam AM,2 Seman Endogynaecology, Flinders Medical Centre, Adelaide, SA, Australia; 2 Centre for Advanced Reproductive Endosurgery, Sydney, NSW, Australia; 3 Flinders Medical Centre, Bedford park, SA, Australia *Corresponding author. Study Objective: To present our experience of treating vaginal mesh exposure with various modalities including Platelet Rich Plasma (PRP) and Co2 Laser Design: Prospective cohort study Setting: Patients referred to a gynecologist with a special interest in urogynaecology who worked at Adelaide, Sydney, and Geelong Patients or Participants: 34 patients with symptomatic mesh exposure between 2009 and 2018 Interventions: All patients were offered treatment with vaginal topical estrogen. Patients who continued to be symptomatic were treated with either PRP alone or surgical excision and PRP injection. These patients have been followed up on an annual basis since the time of treatment. Measurements and Main Results: 5 women declined topical estrogen due to personal or family history of Breast cancer
4 patients received PRP and had complete re-epithelialization of the vaginal mucosa
1 patient received combined PRP and laser 29 Women used vaginal estrogen
6 women responded to long-term (3-6 months) E2 treatment and needed no further treatment.
9 were treated with laser and PRP alone
14 women required surgery 4 women did not respond to E2 treatment and did not wish to have surgery; they received PRP and had complete re-epithelialization of the vaginal mucosa. 14 women underwent surgical excision and primary closure with PRP injection at the time
10 had laser and PRP
9 of the 14 women needed no further surgery after six months. 3 women had repeat surgery for further mesh exposure. Conclusion: The treatment of symptomatic vaginal mesh exposure might be complex in some cases. In recurrent cases, multi-modal treatment may be required. PRP and PRP autologous graft may benefit women whose mesh exposure is associated with severe atrophy or where large areas of vaginal epithelium need removal. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION L 2234 Comparing Pain Levels and Blood Loss Following Pelvic Floor Reconstructive Surgery Between Vaginal Packing Soaked with Either Estrogen, Bupivacaine or Saline Jolliffe CJ,1,* Michael A,2 Myrox P,3 Li X,3 Abraham T,2 Kung RC,1 Gagnon LH,1 Bodley J,1 Lee PE1. 1Division of Urogynecology,
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION M 2671 Lefort Colpocleisis Raju R,1,* Occhino JA,1,2 Linder BJ1,2. 1Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN; 2Division of Urogynecology, Mayo Clinic, Rochester, MN *Corresponding author. Video Objective: To present the technical considerations and pearls to performing a LeFort Colpocleisis. Setting: Patient is a 76 year old female with history of a vaginal bulge for the past 6 months and a failed pessary trial. She also reports urge-predominant mixed urinary incontinence with worsening stress urinary incontinence with reduction of the pelvic organ prolapse. She is not sexually active and does not plan on any future sexual activity. She does not have any abnormal pap smears and denies postmenopausal bleeding. Her past medical history is significant for multiple comorbid conditions including cardiac issues with a pacemaker, chronic kidney disease, hypertension and diabetes. Her past surgical history is complicated by aortic valve replacement (porcine valve), tubal ligation and a left total knee replacement. On exam she has a Stage IV uterine, anterior and posterior compartment prolapse with positive occult stress urinary incontinence. Urodynamic studies reveal stress urinary incontinence, no detrusor overactivity and an elevated post void residual (125 ml after
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
241 ml void). She was counseled regarding management options including conservative options (observation or repeat pessary trial), restorative procedures (vaginal vault suspension or sacrocolpopexy), or an obliterative procedure such as a LeFort Colpocleisis. Interventions: The patient opted for a LeFort Colpocleisis. She underwent a Dilation and curettage, a LeFort colpocleisis, Posterior colpoperineorrhaphy, Cystoscopy and a Midurethral Sling Placement. Conclusion: The technical considerations for performing a LeFort Colpocleisis include ruling out malignancy prior to surgery, adequate lateral channels for uterine drainage, the use of lidocaine with epinephrine, closure in multiple layers with excellent hemostasis and an aggressive posterior colpoperineorrhaphy.
Endoscopy Unit, Clınica del Prado, Medellın, Colombia; 3Obstetric and Gynecology Journal, CES University, Medellin, Colombia *Corresponding author.
Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION N 1406 Same-Day Discharge Following Vaginal Hysterectomy with Pelvic Floor Reconstruction: A Pilot Study Liu LA,1,* Yi J,2 Wasson MN3. 1GYN, Lenox Hill Hospital, New York, NY; 2 Mayo Clinic, Phoenix; 3Mayo Clinic Arizona, Phoenix, AZ *Corresponding author. Study Objective: Determine safety and feasibility of same-day discharge in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design: Prospective cohort pilot study. Setting: Single academic medical center. Patients or Participants: Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions: Same-day discharge or overnight hospitalization following surgery. Measurements and Main Results: A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women that were planned for overnight hospitalization. The intervention group had 36 women that were planned for same-day discharge. In the intervention group, 63.9% of patients (n=23) were successfully discharged home and 36.1% (n=13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness) (n=9; 69%), uncontrolled pain (n=1, 7.7%), fever (n=1, 7.7%), anemia (n=2, 15.4%), with return to operating room for hematoma evacuation (n=1; 7.7%). Voiding trial was passed on first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = 0.011). There were no significant differences in the number of emergency department visits (p=0.677) or unplanned office visits (p=0.193) between the control and intervention groups. Conclusion: Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same-day did not require a higher volume of emergency department or office evaluations. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION O 1820 Resection of Uterus, Fallopian Tubes and Gonades by Laparoscopy in Patient with Sexual Ambiguity noz MA3. 1Gynecological Gomez-Correa SM,1,* De Los Rios JF,2 Mu~ Endoscopy Unit, Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) AAGL, Clinica del Prado, Medellin, Colombia; 2Gynecological
Video Objective: Describe a clinical case of a patient with sexual ambiguity and his laparoscopic surgical treatment. Setting: 33-year-old patient with a sexual ambiguity and male identification who required resection of gonads and atrophic organs. was performed in Prado Clinic in Medellin, Colombia. Interventions: Laparoscopic hysterectomy plus gonadal resection was performed in a patient with a male phenotype in whom uterine manipulator placement wasn’t possible. Conclusion: In this moment, focus on sexual ambiguity has been changed. Now there is a greater emphasis on a conservative approach and the delay of irreversible surgery until adulthood. That new approach allows the individualization of the patient and makes surgical decision once a gender identity is presented. Laparoscopic surgery has been found to be a tool for the adequate treatment that allows a complete visualization of the atrophic organs and gonads. Generating almost imperceptible scars in the long term and preventing possible malignant transformation in the future. Virtual Poster Session 4: Urogynecology (1:10 PM — 1:20 PM) 1:10 PM: STATION P 1201 Laparoscoic Supracervical Hysterectomy and Sacrocervicopexy Using Flexdex’s Platform Technology with Extraction of The Surgical Specimen by the Posterior Colpotomy for the Treatment of Uterine Prolapse Souza CA,1,* Pazello RT,2 Hajar F3. 1School of Minimally Invasive Surgery, Instituto Crispi, Rio de Janeiro, Brazil; 2Servi¸c o de cirurgia laparoscopica, Ophera, Curitiba Paran a, Brazil; 3Universidade Federal do Paran a, Curitiba, Brazil *Corresponding author. Video Objective: Demonstrate the functionality and capabilities of the FlexDex platform in a high technical complexity procedure, a videolaproscopy supracervical hysterectomy with cervicosacropexy. Setting: A 76-years-old patient with uterine prolapse (POP-Q stage III) was selected for laparoscopic treatment with the aid of the FlexDex platform. Interventions: Initially, the supracervical hysterectomy was performed, followed by the cervix closure and the opening of the peritoneum at the level of the promontory − identifying the hypogastric nerve, lateralizing it with the endopelvic fascia and medializing the mesosigmoid fascia for the development of the pararectal space. Thus, allowing continuity to rectovaginal space and preparing the mesh bed. Next, a lightweight, macroporous, Yshaped polypropylene mesh was fixated to the cervix stump − being assisted by the FlexDex platform, which enables the suturing to be made backhanded in a angulated topography. Then, the anatomical landmarks were identified before proceeding to the sacropexy - middle sacral vessels, sacral promontory, anterior longitudinal ligament, aortic bifurcation, inferior vena cava, right common iliac vessels and right ureter. After the mesh fixation to the promontory, the burial of the mesh was achieved with the closure of the peritoneum with a continuous suture. All the suturing during the surgery was accomplished utilizing only one trocar arrangement, enabled by the virtual center of rotation of the FlexDex platform. The surgical specimen was removed by posterior colpotomy, avoiding its morcellation. Once again, the closure of the posterior vaginal wall was facilitated by the endless rotation of the platform, enabling the ideal movement of the needle, following its curvature. Conclusion: The FlexDex platform allows similar amplitude and intuitive wrist movement of the surgeon during complex procedures such as the one here presented − being a cost-effective alternative to the robot technology in countries where it is not readily available.