Infra-umbilical Hasson, 5mm ports in RIF x2 and LIF
RLQ port needs to be above level ASIS to allow it to get across pelvic brim
RUQ port needs to be more medial to allow triangulation on pelvis
Left lateral port at level of umbilicus, doesn't really matter exactly where
Straight needle to stitch uterus out of the way
Assess abdomen, particularly for redundant sigmoid
Use endoloop brought out through the left port on an epiploic appendage to hoist up sigmoid
Identify landing zone on sacrum - look for the flat shelf
Use hook to create peritoneal flap from sacrum to peritoneal reflection, curving on the right of the rectum through to anterior to rectum
Dissect rectovaginal/rectoprostatic plane
DRE to confirm reached just above pelvic floor
Use assistant with an A-trak lifting upwards, look carefully for SV/prostate in man and vagina in woman
Bleeding indicates wrong plane
Ti-mesh - cut a diagonal strip, 15cm long or so, along the line that doesn't stretch. The distal end should flare slightly.
Other mesh options - BioDesign rectopexy graft; Phasix; BioA
6x distal sutures in two rows
A mid-rectum suture may be required too
2x AbsorbaTacks (ideally protacks) to hold mesh in place, then a big deep suture (can use the big needle Prolene, I think it was 0 Prolene on a big chunky needle)
Suture peritoneal flap closed with 2/0 absorbable V-lok
