Laparoscopic Lateral Suspension According to Dubuisson: Technical Video Guide with Tips and Tricks.

Abstract

<h4>Objective</h4>This video illustrates key technical steps and refined strategies to improve safety, precision, and reproducibility when performing Laparoscopic Lateral Suspension (LLS) for the treatment of pelvic organ prolapse (POP).<h4>Setting</h4>This video includes intraoperative laparoscopic video footage performed at the Division of Gynecology and Obstetrics at the University Hospital of Cagliari, Italy.<h4>Participants</h4>The case presented involves different women with stage II-III cystocele and apical prolapse, with preserved uterine anatomy and no significant posterior compartment defect.<h4>Interventions</h4>All patients underwent LLS to surgically treat POP using a T-shaped prosthetic mesh fixed to the uterine cervix or isthmus and the anterior vaginal wall, with arms suspended retroperitoneally and tension-free to the lateral abdominal wall. The procedure included six tips and techniques: bladder suspension technique to the anterior abdominal wall with the use of a Foley segment; accurate measurement of the anterior vaginal wall with a segment of a Foley catheter; optimal mesh tailoring; use of a 10-mm suprapubic trocar; application of the first stitch on the anterior vaginal wall; and peritoneum traction to improve procedural outcomes. These steps were presented as a standardized, step-by-step process to improve intraoperative exposure, control mesh deployment and arm traction, and enhance overall reproducibility of LLS.<h4>Conclusion</h4>LLS may be an alternative to laparoscopic sacral colpopexy, particularly for cystocele and apical prolapse repair when promontory access is difficult. The refinements presented here aim to increase reproducibility and intraoperative control during vesicovaginal dissection, mesh sizing, and retroperitoneal tunneling. The dual use of a Foley segment for atraumatic bladder retraction and standardized measurement offers a low-cost strategy, while stepwise mesh deployment and gentle peritoneal traction support safe, consistent suspension.