Innovative Biological Augmentation of Level Two Pelvic Organ Prolapse with Autologus Graft

Abstract

Video Objective This first segment of the video will describe the process involved in preparing an autologous graft derived from platelet rich plasma. The latter segment of video will demonstrate the surgical technique involved in the incorporation of autologous graft into a standard native tissue repair. We will then review our prospective cohort data with up to 18 months follow up. Setting Pelvic organ prolapse is a condition with a lifetime surgical risk of 10-20%. Native tissue repair alone is associated with a failure rate often quoted as around 30-50%. With the withdrawal of vaginal mesh and xenograft products from the market by the TGA and other regulatory bodies due to complications, Gynecologists are faced with managing complex pelvic organ prolapse cases with less tools in their armamentarium. Platelet rich plasma and autologous tissue grafts have been successfully used in plastic and reconstructive surgery, orthopedics and dentistry. We describe an innovative technique to biologically augment a native tissue vaginal repair. Interventions Patient blood is taken at the commencement of the procedure in the operating theatre and centrifuged to produce platelet rich plasma and fibrinogen. This is then mixed with calcium gluconate in a pre-defined ratio prior to further processing in a centrifuge. This creates a 3-4cm autologous biological graft which is able to be sutured to the vesicocervical or pararectal fascia to biologically augment a native tissue repair. Results There have been 30 cases of PRP membrane augmented vaginal repairs. Baseline characteristics was compared to follow-up. Results of the study and video of the autologous membrane will be presented at the conference. Conclusion This video demonstrates the preparation of the autologous graft which is being evaluated as a technique to be easily incorporated into standard practice to augment a vaginal native tissue repair and reduce the risk of recurrence.