case_images: PMC6216082_01
case_images: Prolaps POP-Q 4 - preoperative consideration.
case_images: gr1.jpg
case_images: PMC6216082_01_gr1.jpg
case_images: fig0005
case_images: A close inspection of the lower pelvic region showed unremarkable left adnexa and barely visible ones on the right that were located along with the hernial sac inside the vagina (Fig. 1).
case_images: Preparation of the sacro-promontory.
case_images: gr2.jpg
case_images: PMC6216082_01_gr2.jpg
case_images: fig0010
case_images: After presentation of the right ureter, the peritoneum was opened over the sacrum on the promontorial level and the anterior longitudinal ligament of the spine was exposed without injuring the inferior hypogastric plexus or the median sacral artery (Fig. 2).
case_images: View of the posterior cervical wall after the preparation.
case_images: gr3.jpg
case_images: PMC6216082_01_gr3.jpg
case_images: fig0015
case_images: Next, an incision was made on the parietal peritoneum on the dorsal wall of the cervix uteri and it was partially separated from the cervix (Fig. 3).
case_images: Niemeyer Helix.
case_images: gr4.jpg
case_images: PMC6216082_01_gr4.jpg
case_images: fig0020
case_images: Using a Niemeyer Helix (Fig. 4), which was inserted directly through the abdominal wall, a retroperitoneal tunnel was formed between the promontorium and the cervix uteri, following the anatomical location of the right uterosacral ligament (Fig. 5).
case_images: Mesh (tape) used by the operation.
case_images: gr6.jpg
case_images: PMC6216082_01_gr6.jpg
case_images: fig0030
case_images: A 20 x 1 cm polypropylene mesh was used for the procedure (Fig. 6).
case_images: Fixation of the tape on the cervix.
case_images: gr7.jpg
case_images: PMC6216082_01_gr7.jpg
case_images: fig0035
case_images: Next, the distal end of the mesh was anchored to the cervix with non-absorbable interrupted sutures 2-0 (Fig. 7).
case_images: Fixation of the tape on the anterior longitudinal ligament at the sacro-promontory.
case_images: gr8.jpg
case_images: PMC6216082_01_gr8.jpg
case_images: fig0040
case_images: The proximal end of the graft was attached to the right side of the longitudinal anterior ligament of the sacral spine with the same type of sutures (Fig. 8).
case_images: Postoperative consideration without prolapse.
case_images: gr9.jpg
case_images: PMC6216082_01_gr9.jpg
case_images: fig0045
case_images: The wound was closed with continuous stitches, narrowing the vestibule of the vagina and maintaining proper anatomy (Fig. 9).