The use of one-piece U-shaped mesh and barbed sutures in laparoscopic sacrocolpopexy

Abstract

IntroductionLaparoscopic Sacrocolpopexy (LS) is considered a safe and effective surgery for the treatment of Pelvic Organ Prolapse (POP), but it requires expertise in laparoscopic surgery. The complexity of the intervention is due to the requirements of intracorporeal sutures and the manipulation of the mesh inside the cavity, which may be cumbersome. The barbed sutures (BS) simplify intracorporeal suturing and do not require knotting. Additionally, one-piece U-mesh (OP-UM) may facilitate handling, stabilization and tension adjustment. We describe our LS surgical technique using both materials to assess its feasibility, safety and effectiveness in a prospective series of patients. Materials and methodsA total of 7 patients with symptomatic POP were included. Urogynecological history, classification of the POP according to Baden-Walker and the application of the Prolapse Quality of Life questionnaire were performed in all cases. The non-absorbable polypropylene OP-UM (Uplift™) was used. The posterior side of the single sling is sutured to the elevator anus muscles with two non-absorbable stitches. Two strands of BS (V-Loc™), tied at their ends, were used to attach the mesh to the vagina in two lines of continuous sutures in opposite directions. Self-anchoring tackers were used for promontofixation and BS for peritoneal closure. ResultsThe median age was 60 years, the median time of the anterior branch mesh BS fixation was 23 minutes (range 2130–2640 min), intraoperative bleeding was minimal, and the median hospital stay was 3 days. No intraoperative complications were recorded, and no mesh erosions or recurrences were observed at a median follow-up of 14 months (range 3–25 months). All patients presented clinical improvement of the prolapse and were satisfied with surgery. We observed that the OP-UM self-stabilizes when it extends longitudinally into the abdominal cavity, reducing the need of the surgical assistant. The independent promontofixation of each part of the mesh (posterior and anterior) allows a more anatomical tension adjustment. Fixing the mesh to the vagina is fast and simple with our BS technique. ConclusionsThe use of OP-UM and BS during LS is feasible, safe, effective and could simplify this surgical technique.