Abstract
The study aimed to examine the learning curve and perioperative complications for laparoscopic pectopexy (LP). A total of 60 women with stage II–IV apical prolapse who underwent LP were dichotomized into groups: LSH(+) with concomitant laparoscopic supracervical hysterectomy (LSH), LSH(−) after previous supracervical/total hysterectomy. Operative time, estimated blood loss and hospitalization length were evaluated with cumulative sum (CUSUM) analysis and the Kwiatkowski–Phillips–Schmidt–Shin (KPSS) test, separately for two surgeons (A and B). Intraoperative and perioperative complications according to the Clavien–Dindo (C–D) classification were analyzed. Mean operative time, change in hemoglobin level, and postoperative hospital stay were 143.5 ± 23.1 min—1.5 ± 0.5g/dL and 2.5 ± 0.9 days, respectively. LSH during pectopexy was associated with longer operative time (p = 0.01) but not with higher intraoperative bleeding or prolonged hospital stay. Severe complications rate was low (1.7%) with one bowel injury in LSH(−) (C–D grade IIIb). No C–D grade II, IV and V complications were found. Conversion to open pectopexy, return to the operating room or blood transfusion were not required. The KPSS test showed that a steady operative time for Surgeon A was achieved after 28 procedures. A proficiency for laparoscopic pectopexy based on CUSUM analysis was observed after 38–40 procedures.
Highlights
Pelvic organ prolapse (POP) is a common health problem, with the prevalence up to 50% when based upon vaginal examination
An observational study was conducted in 60 consecutive symptomatic women with apical prolapse II–IV Pelvic Organ Prolapse Quantification (POP-Q) stages, who underwent
A proficiency based on cumulative sum (CUSUM) analysis was observed after 38–40 laparoscopic pectopexies, with a steady operative time achieved after 28 procedures
Summary
Pelvic organ prolapse (POP) is a common health problem, with the prevalence up to 50% when based upon vaginal examination. Apical vaginal support is considered the keystone of pelvic organ support [2], it is the least frequent of all POP types with the range of 5–15%. It can be corrected by abdominal, vaginal and minimally invasive surgery [2,3]. Conversion rates and operative time for LS have decreased over the years [10] Limitations such as patient obesity [11] or obstructed defecation syndrome caused by injury of the hypogastric nerves and reduced pelvic space [10] have brought new techniques to light, e.g., laparoscopic pectopexy (LP). In a randomized single-center trial comparing LP with LS, comparable if not effective POP treatment, with no severe complications, was demonstrated [14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
