Abstract
The aim of this review is to investigate and compare all laparoscopic techniques that can be used in the surgical repair of advanced uterine prolapse. A systematic search of the PubMed, Scopus, Cochrane CENTRAL, and Clinicaltrials.gov databases was performed for articles published up to December 2020, reporting data on the treatment of severe uterine prolapse using laparoscopic procedures. Only studies in the English language, with a patient sample of ≥20 and a follow-up time of ≥12 months were included. The final synthesis of this review consisted of six studies. The main laparoscopic procedures reported were vaginally assisted laparoscopic sacrocolpopexy, vaginally assisted laparoscopic uterine sacropexy, laparoscopic sacrocolpopexy with laparoscopic supracervical hysterectomy, laparoscopic inguinal ligament suspension with uterine preservation, and laparoscopic uterosacral ligament suspension combined with trachelectomy. All procedures involved mesh placement, except for laparoscopic uterosacral ligament suspension. All procedures reported anatomical cure rates > 90%. Vaginally assisted laparoscopic sacrocolpopexy had the largest amount of intraoperative blood loss whilst vaginally assisted laparoscopic uterine sacropexy was associated with bladder injuries intraoperatively. All vaginally assisted procedures reported cases of mesh extrusion postoperatively. Laparoscopic inguinal ligament suspension was the operation with the longest mean operative and hospitalization time. Conversions were not reported. The present study shows that minimally invasive surgery can be used efficiently as an alternative to open surgery in the treatment of severe uterine prolapse.
Highlights
IntroductionPelvic organ prolapse (POP) is defined as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy) [1]
BackgroundPelvic organ prolapse (POP) is defined as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, uterus, or the apex of the vagina [1]
The database search using the aforementioned combination of keywords identified 349 records from PubMed (n = 269), Scopus (n = 63), Cochrane Library (n = 17), and ClinicalTrials.gov (n = 0)
Summary
Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy) [1]. Based on the pelvic organ prolapse quantification (POP-Q) system, there are five stages of prolapse severity, with stages III-IV representing the most advanced/severe cases of POP [2]. The exact prevalence of anatomically advanced prolapse in the general population is difficult to establish and most data regarding the distribution of pelvic organ support in women are based on gynecologic clinic populations. In three different observational studies reporting on the prevalence of severe POP in women undergoing annual pelvic examination, the percentage of women with POP stage ≥ III was estimated at 0.6-2.6%, depending on the study [7,8,9]
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