Design: Video case presentation

Setting: The patient was positioned in dorsal lithotomy position. Laparoscopic entrance was at Palmer’s point using direct visual entry technique. Laparoscopy was performed using a 5mm umbilical port, 8mm left upper quadrant port, 5mm left lower quadrant port, and 5mm right lower quadrant port.

Patients or Participants: This is a single case presentation of a patient who underwent pelvic organ prolapse surgery. She was seen for follow up at 2 weeks, 6 weeks, and 5 months post-operatively.

Interventions: This patient underwent total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, anterior and posterior repair, sacrospinous ligament fixation, and cystoscopy. This video highlights the sacrospinous ligament fixation performed under laparoscopic guidance.

Measurements and Main Results: The case presented has a history of a J pouch and during laparoscopy it was noted that the pouch was densely adhered to the right pararectal space. Given the location of the pouch, a uterosacral ligament suspension was unable to be performed and a left sacrospinous ligament fixation was instead chosen for apical suspension. Since the J pouch crossed the midline, the decision was made to complete the left sacrospinous ligament fixation under laparoscopic guidance to prevent injury.

Conclusion: Apical suspension can be successfully and safely completed in a patient with a J pouch using the techniques described in this video.