The vaginally assisted laparoscopic sacrocolpopexy: a pilot study

Abstract

We assessed the efficacy and safety of an operative technique, the vaginally assisted laparoscopic sacrocolpopexy (VALS), for the treatment of women with severe uterovaginal prolapse (UVP). A prospective pilot study of women with severe UVP, who underwent VALS, was carried out. Preoperatively, POP was assessed using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system and symptoms were evaluated using the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (ICIQ-VS). VALS is a combined minimally invasive surgical approach where a vaginal hysterectomy is initially performed, followed by a transvaginal placement of a synthetic mesh which is suspended laparoscopically on the sacral promontory. Postoperative assessment at 12 months was identical to the preoperative assessment with the addition of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Perioperative and postoperative complications were recorded. Twenty-seven women with a mean age of 57.2 (range, 47-73) were included. Twenty women (74.1%) had stage 3 and 7 (25.9%) had stage 4 POP with a median point C = +5 (range, +2 to +8). VALS was successfully performed in all patients. All patients completed their follow-up assessment at 12 months. All POP-Q points showed statistically significant improvement apart from TVL, which remained unchanged. ICIQ-VS scores showed a statistically significant improvement of the vaginal symptoms and the total quality of life. The sexual matters score showed a tendency towards improvement, although it did not reach statistical significance. Vaginally assisted laparoscopic sacrocolpopexy appears to be a valid and safe minimally invasive option when treating women presenting with severe UVP, with encouraging short-term anatomical and functional outcomes.