Abstract
Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n = 135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity = 2.49) and overweight (mean BMI = 27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intra-operative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.
Highlights
We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons
The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%)
Recent advances in minimally invasive surgery have led to the development of a laparoscopic approach to apical prolapse repair, which combines the effectiveness of sacrocolpopexy with the reduced morbidity traditionally associated with the vaginal approach.[4]
Summary
We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Pelvic organ prolapse (POP) is a common condition worldwide,[1] and the demand for reconstructive surgery is expected to increase by 45% over the three decades due to aging.[2] Despite the evolution of surgical management options, POP continues to be associated with recurrence rates as high as 50–60%.3. Three main components to POP are recognized: anterior, posterior and apical support defects. Posterior and anterior defects are most commonly treated via vaginal approach, while abdominal sacrocolpopexy with mesh is currently considered the first option treatment for apical prolapse.[3] Recent advances in minimally invasive surgery have led to the development of a laparoscopic approach to apical prolapse repair, which combines the effectiveness of sacrocolpopexy with the reduced morbidity traditionally associated with the vaginal approach.[4]
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