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A Pilot Study of Kocher Forceps-Guided Laparoscopic Transvaginal Sacrospinous Ligament Fixation: Technique and
Bai Xue1, Xiaoyan Huang1, Ying Zhou1
1Department of Gynecology and Obstetrics, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, People's Republic of China.
Background:
Traditional transvaginal sacrospinous ligament fixation (SSLF) relies on palpation for suture placement under limited visualization. We developed a Kocher forceps-guided laparoscopic transvaginal SSLF technique that enables real-time laparoscopic visualization during suturing and eliminates the need for specialized transvaginal natural orifice transluminal endoscopic surgery (vNOTES) access platforms and insufflation. This study presents this novel technique and reports our initial clinical experience.
Methods:
Ten consecutive patients with pelvic organ prolapse (POP) who underwent this procedure at the Affiliated Jiangning Hospital of Nanjing Medical University between November 2024 and July 2025 were included. After opening the rectovaginal and right pararectal spaces, the sacrospinous ligament was identified by palpating the ischial spine. The surgeon then grasped the target site with a Kocher forceps and placed the suture under direct laparoscopic visualization. Demographic, preoperative, intraoperative, postoperative, and follow-up data were evaluated.
Results:
Ten postmenopausal women with stage III-IV POP successfully underwent the procedure. Median age was 64 years (range, 54-71), and median body mass index (BMI) was 24.30 kg/m2 (range, 19.53-27.56). Concomitant procedures included hysterectomy with anterior and posterior colporrhaphy (n=5), partial cervicectomy with anterior colporrhaphy (n=1), partial cervicectomy with posterior colporrhaphy (n=1), and anterior and posterior colporrhaphy alone (n=3). Median operative time was 140 minutes (range, 82-230), and median estimated blood loss was 50 mL (range, 10-100). No perioperative complications occurred. At a median follow-up of 15.62 months (range, 2.27-17.03), no POP recurrence or surgical complications were observed.
Conclusion:
The Kocher forceps-guided laparoscopic transvaginal SSLF appears to be a feasible and safe surgical approach for POP in this small case series.
