Abstract
Abdominal sacral colpopexy/hysteropexy is the gold standard for the treatment of vaginal apex support. However, dissection of the promontory may expose to potentially life-threatening complications. To avoid this risk, laparoscopic lateral suspension with mesh is an alternative. Robotic assistance may be helpful in both techniques. The objective of our study was to evaluate outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical pelvic organ prolapse (POP). From March 2012 to January 2018, 59 consecutive patients underwent RALLS using titanized polypropylene mesh. Between August 2017 and September 2019, all patients were contacted to assess outcome. We performed a clinical exam and asked them to complete the patient global impression of improvement (PGI-I) questionnaire. Fifty-four patients (91.5%) were available for follow-up. Mean age was 58.5 years (28.8–79.8). There were no perioperative complications. The mean follow-up was 33.6 months (11.2–74.1).The objective cure rate (no prolapse beyond hymen) and the subjective cure rate (PGI-I ≤ 2) were 83.3% and 77.2%, respectively. Five women (9.3%) were reoperated for POP recurrence. There was no erosion. Of the 20 women complaining of stress urinary incontinence (SUI) preoperatively, 12 (60%) were cured without any additional SUI procedure. Only two women (10%) required TVT for persistent grade 2 SUI. Two women (5.9%) developed de novo SUI, but none of them required an operation. RALLS repair for POP with mesh is safe and effective and may represent an alternative to sacral colpopexy/hysteropexy.
Highlights
Pelvic organ prolapse (POP) is a frequent condition impairing women’s quality of life
Sacrocolpopexy is associated with potentially serious complications such as life-threatening vascular injuries, ureteric damage, vertebral osteomyelitis, and nerve injuries resulting in chronic constipation and pain [5]
We performed a clinical exam with Prolapse Quantification system (POP-Q) assessment and asked them to refill a patient global impression of improvement (PGI-I) questionnaire to evaluate long-term satisfaction with the procedure
Summary
Pelvic organ prolapse (POP) is a frequent condition impairing women’s quality of life. Abdominal sacral colpopexy/hysteropexy (ASCP) is the gold standard for the treatment of apical vaginal and uterine prolapse [2]. Journal of Robotic Surgery morbidity associated with transabdominal procedure [3]. Access to robotic assistance made conversion from open to laparoscopic surgery more feasible without impairing results [4]. A difficult step for this procedure is the dissection of the sacral promontory to access the anterior longitudinal ligament where the mesh will be fixed. In 1967, Kapandji first described an alternative method to the ASC, which avoided the dissection of the sacral promontory and reduced its related risks. The procedure consisted in attaching the anterior vaginal wall and the uterine isthmus to the anterior–superior iliac spine with a mesh [6]. Associated procedures were not standardized sometimes using mesh to treat posterior defect, sometimes posterior colporrhaphy or McCall culdoplasty, with a large proportion of women having concomitant subtotal hysterectomy or preventive Burch colposuspension
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