Laparoscopic and Robotic Mesh-Free Suture Hysteropexy Versus Mesh Sacral Hysteropexy: A Non-Randomised Comparison

Abstract

Study Objective To compare the laparoscopic and robotic mesh-free suture hysteropexy (SutureH) with mesh sling sacral hysteropexy (MeshH) for uterine prolapse. Design A retrospective clinical audit of consecutive women who underwent SutureH or MeshH by laparoscopic or robotic route by a single surgeon. Subjects were assessed at baseline, 5-weeks and 1-year. Setting N/A Patients or Participants N/A Interventions SutureH uses sutures to re-support the uterus from each uterosacral ligament. During MeshH, the uterus is suspended form the sacral promontory using a mesh sling placed around the cervix. All women had a post-operative surgical support pessary placed for 5 weeks. Measurements and Main Results The primary outcome was success defined as a composite of: POP-Q C-point above the hymen, absence of vaginal bulge symptom, and no repeat prolapse surgery or pessary placement. Secondary outcomes included subjective improvement in prolapse symptoms using PGI-I, POP-Q C-point change, change in POP-Q scores and complications. 228 women underwent laparoscopic or robotic hysteropexy between Sept 2010 and Oct 2018. The 1-year data was available for 191 women (MeshH n=120; SutureH n=71). Success was not different between MeshH and SutureH (P=0.114). For MeshH v's SutureH, C-point at or above -1cm, absence of bulge and no repeat surgery was 99.2% v's 95.8%, 90.8% v's 90.1% and 81.7% v's 84.5% respectively (NS). MeshH (mean C point -7.14 cm) provided better apical support than SutureH (mean C point -5.9) (P Conclusion Laparoscopic and robotic sutureH and meshH provide women with minimally invasive durable options for uterine preservation during pelvic organ prolapse surgery. When controlling for age, MeshH provided better anatomic support than SutureH although SutureH gives women a mesh-free option.