Laparoscopic Lateral Suspension Research Articles

A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results.

Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien-Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. LLS is a good alternative to LSC, with promising anatomical and quality-of-life results.

Results of the laparoscopic lateral suspension and laparoscopic sacrocolpopexy techniques done for uterine prolapse

Background/Aim: Sacrocolpopexy is considered the gold-standard surgical treatment for patients with symptomatic uterine prolapse. This technique can be performed using a laparoscopic approach. Laparoscopic lateral suspension has emerged as a new alternative pelvic organ prolapse surgery method. This study aims to compare the postoperative anatomical improvement and sexual function outcomes in patients who underwent laparoscopic sacrocolpopexy (Group 1) versus laparoscopic lateral suspension (Group 2) for pelvic organ prolapse at our institution. Methods: Group 1 consisted of 14 patients, while Group 2 comprised seven patients. Relevant data were collected using the Turkish-validated Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), A Simple Questionnaire to Screen for Sexual Dysfunction, and the Pelvic Organ Prolapse Quantification System (POP-Q) questionnaires. Results: There was no statistically significant difference between Group 1 and Group 2 in terms of the preoperative stage of uterine prolapse (2.6 (0.8) vs. 2.7 (0.7) [P=0.534]). The postoperative period was significantly longer in Group 1 compared to Group 2 (1,014.7 (348.8) days vs. 598.4 (276.5) days [P=0.013]). In the POP-Q evaluation, point C was measured as -6.6 (1.1) cm in Group 1 and -5.2 (1.5) cm in Group 2, indicating a statistically more proximal location (P=0.037). The total vaginal length was greater in Group 1 than in Group 2, but this difference was not statistically significant (8.7 (1.2) cm vs. 8.1 (1.3) cm, [P=0.343]). There was no statistical difference between the groups in terms of uterine prolapse stages and sexual function during the follow-up period. Conclusion: Laparoscopic lateral suspension is an alternative method for patients with uterine prolapse, offering comparable anatomical and sexual outcomes to laparoscopic sacrocolpopexy.

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention

Laparoscopic Treatment of Bladder Prosthesis Exposure

Genital prolapse surgery is a functional surgery aimed at restoring the anatomical position and functions of the pelvic organs. Currently, the gold standard is laparoscopic surgery with a polypropylene prosthesis. This is functional surgery involving the interposition of strips and their fixation to the spine. This technique avoids the need for a vaginal opening and is therefore less prone to infectious complications and prosthesis exposure. Exposure of the prosthesis several years after insertion calls for monitoring. We present the case of a patient operated on at our level for genital prolapse using the laparoscopic lateral suspension technique, with exposure of the sling three years after insertion. We describe the various lesions found and the therapeutic strategy.

Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study.

This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.

Postoperative results of laparoscopic lateral suspension operation: A clinical trials study.

Pelvic organ prolapse surgery carries potential risks, and Laparoscopic lateral suspension (LLS) surgery is being performed in increasing numbers with advances in minimally invasive surgery. Our study aims to report the postoperative results of LLS operations. 41 patients at POP Q stage 2 and above underwent LLS operations in a tertiary center between 2017 and 2019. Postoperative patients 12 (12-37) months and older were evaluated in terms of anterior and apical compartments. In our study, laparoscopic lateral suspension (LLS) was applied to 41 patients. The mean age of all patients was 51.45 ± 11.51, and the operation time was 71.13 ± 18.70 min, The mean hospital stay was 1.35 ± 0.4 days. The apical compartment success rate was 78% and the anterior compartment success rate was 73%. In terms of patient satisfaction, 32 (78.1%) patients were satisfied, While 37 (90.1%) patients did not have abdominal mesh pain, 4 (9.9%) patients had mesh pain. Dyspareunia was not observed. Laparoscopic lateral suspension in pop surgery; Considering the success rate below expectation, some patient groups can be applied as an alternative surgical method.

A comparative study in learning curves of laparoscopic lateral suspension vs. laparoscopic sacrocolpopexy: preliminary results.

Determination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves of different techniques in laparoscopic pelvic floor surgery. The aim of this study was to compare the learning curve of two operative techniques, laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC). We conducted a prospective study to assess the learning curve of LLS and LSC by implementing a structured urogynecologic surgical training program with the use of pelvic trainers for our urogynecology fellow. The fellow was an experienced urogynecologic surgeon, but was laparoscopic suturing and dissection naive at the beginning of the study. She was required to assist in 20 laparoscopic urogynecologic surgeries and undertake laparoscopic suturing and knot tying training with mesh positioning on a laparoscopic trainer for 4 h/week during the trial period. After the completion of this structured training program, the fellow performed LLS and LSC under the supervision of an experienced subspecialist as the primary surgeon. Linear regression analysis was used to compare the data of LLS and LSC learning curves. Subjective pre- and post-operative evaluation of pelvic organ prolapse (POP) and pelvic floor disorders was undertaken preoperatively and 12 months postoperatively using the PFDI-20-Quality of Life validated questionnaire. Follow-up was scheduled 12 months after the surgery and performed by a skilled urogynecologist. Objective cure was defined as Pelvic Organ Prolapse-Qualification (POP-Q) stage <II in any compartment. The mean operative times of laparoscopic sacrocolpopexy and lateral suspension were 168.26 and 160.33 min, respectively. According to linear regression analysis after 43 procedures, the learning curve for laparoscopic lateral suspension was shorter than for laparoscopic sacrocolpopexy (OPTime 134.69 min). In both groups, there was a significant reduction in bothersome POP symptoms (p ≤ 0.005). Bladder injuries in two cases and lumbar pain in one case were recorded during the study. Overall objective success at 12 months was 90.7% for LSC and 89.1% for LLS. Laparoscopic lateral suspension could be an alternative to laparoscopic sacrocolpopexy in the treatment of POP with its good objective and subjective outcomes. Lateral suspension has a shorter learning curve, and it is technically less demanding than LSC. Procedure-dedicated training can accelerate the move from a novice to a master laparoscopic surgeon.

Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem?

The laparoscopic lateral suspension (LLS) represents an alternative mesh procedure to avoid the dissection at the promontory. However, mesh-related complications such as chronic pelvic pain, dyspareunia, and bladder pain are emerging. The present study is aimed to present a video case report and describe a small case series of patients referred to our center for chronic pelvic pain after LLS. A surgical video of the management of a 50-year-old woman with chronic abdominal and pelvic pain, dyspareunia, and recurrent urinary tract infection (UTIs) after uterus sparing LLS is provided. Moreover, we performed a retrospective chart review of similar cases in our institution. The featured procedure was completed without complications and was successful in obtaining symptom relief. Between 2018 and 2022 five patients underwent total or subtotal mesh removal for pain-related symptoms after LLS. At the median follow-up of 24 months, all patients were free from pain, but two (40%) required reoperation for prolapse recurrence CONCLUSIONS: Our experience suggests that LLS involves a certain risk of chronic pelvic pain, which may be challenging to manage and require surgical treatment.

Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse.

Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p˂0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.

Laparoscopic Lateral Suspension (LLS) for the Treatment of Apical Prolapse: A New Gold Standard?

Nowadays, the gold standard to treat apical pelvic organ prolapse (POP) is laparoscopic sacrocolpopexy (LSCP). However, LSCP is a difficult procedure associated with rare but potentially severe complications. Promontory dissection may expose to potential life-threatening intraoperative vascular injuries, and sacral roots or hypogastric nerve damage. There are also a few case reports of spondylodiscitis with consecutive lumbar vertebra bone erosion. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical POP repair. It lowers perioperative risks by avoiding sacral promontory preparation. Recent studies show similar anatomical and functional outcomes to LSCP, with the advantage of better preserving the vaginal axis. Moreover, LLS is well suited for hysteropexy which is important as an increasing number of women prefer uterine preservation during POP surgery. In this article, we discuss both techniques, and we share our opinion on a novel perspective in the treatment of apical POP with uterine preservation.

Reliability of laparoscopic lateral suspension videos on YouTube platform

Objective: YouTube is one of the most popular websites globally and its content is not limited to entertainment. The aim of this study is to evaluate the reliability, quality and quantity of information and surgical steps in YouTube videos about laparoscopic lateral suspension with mesh for the surgical treatment of pelvic organ prolapse (LLS). Material and Methods: A search on YouTube was performed with the key words; " laparoscopic lateral suspension’’, ‘’lateral suspension ", ‘’ pelvic organ prolapse surgery’’, ‘’POPS with mesh’’, ‘’Pelvic Organ Prolapse Suspension’’. Each video was further analysed in terms of reliability, quality and quantity of information. Results: A total of 44 videos were evaluated after excluding 36 of the 88 videos associated with LLS. According to the usefulness score, the videos were divided into two groups. 61.4%(n=27) of the videos were in GroupI (not useful and slightly useful) and 38.6% (n=17) were in GroupII ( useful and very useful). There was no difference between the groups in terms of video length, number of views, number of likes, number of dislikes, number of comments and number of subscribers. A Spearman’s rank correlation analysis found no correlation between the usefulness score and like ratio, views ratio, like / view rate, like/subscriber rate, view/subscriber rate, VPI rates. Conclusion: Since the videos uploaded to YouTube do not pass a preliminary examination, their reliability is low even if they are uploaded by health professionals. There is no relationship between quantitative information of the LLS videos and the usefulness scores of the videos.

Laparoscopic lateral suspension with mesh for the management of pelvic organ prolapse: an educative video (case report)

Laparoscopic lateral suspension with mesh for the management of pelvic organ prolapse: an educative video (case report)

Laparoscopic lateral suspension is an alternative surgical method when there is difficulty in dissection of the promontory of the sacrum due to abnormal vasculature in laparoscopic sacrocolpopexy: A case report

Laparoscopic lateral suspension is an alternative surgical method when there is difficulty in dissection of the promontory of the sacrum due to abnormal vasculature in laparoscopic sacrocolpopexy: A case report

Postoperative Results of Laparoscopic Lateral Suspension Operation

Postoperative Results of Laparoscopic Lateral Suspension Operation

Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

BackgroundLaparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.MethodsData from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used.ResultsThe median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery.ConclusionsIn advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

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.

Anatomical and clinical outcomes of vaginally assisted laparoscopic lateral suspension in comparison with laparoscopic lateral suspension

Background: In this retrospective study, we aimed to describe the surgical procedure for vaginally assisted laparoscopic lateral suspension (VALLS) and to compare its anatomical and clinical outcomes with laparoscopic lateral suspension (LLS). Methods: The surgical outcomes of 26 women with advanced-stage pelvic organ prolapse (POP) undergoing VALLS and 35 women with advanced-stage POP undergoing LLS were retrospectively analysed and compared. The surgical outcomes were documented according to the International Urogynecological Association guidelines. Complications were evaluated according to the Clavien-Dindo classification and classified using the joint project of the International Continence Society and the International Urogynecological Association Prosthesis/Graft Complication Classification System. Results: The results showed significant improvement in all POP Quantification measurements in both the VALLS and LLS groups, with overall objective cure rates of 88.4% and 80%, respectively (96.1% and 91.4%, respectively, for the apical compartment; 96.1% and 85.7%, respectively, for the anterior compartment). The median operation times for VALLS and LLS were 77 [66–90] minutes and 99 [82–125] minutes, respectively (p = 0.001). A significant improvement in POP symptoms was observed in both groups. Occult stress urinary incontinence (SUI) was detected in two (7.6%) VALLS patients, and de novo SUI developed in four (15.3%) VALLS patients post-operatively. Anterior compartment defects were detected in one VALLS and five LLS patients. Mesh erosion was found in one patient in each group. Discussion: VALLS appears to be an effective and reliable surgical method for patients with advanced-stage POP and can offer advantages in terms of operation time and POP recurrence rates.

Laparoscopic lateral suspension for apical vaginal wall prolapse: review article

: Laparoscopic lateral suspension with utilizing mesh for pelvic organ prolapse has gained much attention and popularity globally. Laparoscopic lateral suspension, technique has evolved or modified according to the surgical outcomes and innovation of technology throughout the years since first reported. Laparoscopic lateral suspension aimed to treat apical and anterior vaginal wall prolapse. Laparoscopic sacrocolpopexy has admitted to be gold standard technique for the treatment of apical prolapse. However, it substantially depends on surgical skill and expertise due to dissection at the level of the promontory hence this could be challenging, particularly in obese women and when an anatomical variation exists and this might be associated with rare but serious neurological or ureteral morbidity as well as life-threatening vascular injury. Laparoscopic lateral suspension is technically easier to perform and provides shorter time to operate, as well. Considering apical defect is more common in elderly patient population, shorter surgery time will be an offering of the laparoscopic lateral suspension to this group. Laparoscopic lateral suspension is feasible, reproducible, safe, and effective technique. Hence, laparoscopic lateral suspension should not be evaluated as a replacement procedure to sacrocolpopexy. However, in selected cases it would be a feasible alternative in apical and anterior vaginal wall prolapse.

Mesh-related complications of laparoscopic lateral suspension

Objective: Restorative procedures are essential for sexually active vaginal vault prolapse (VVP) cases. There are concerns about the long learning curve and major complications of sacrocolpopexy. Laparoscopic lateral suspension has a relatively short learning curve and no reported major complications. However, there are concerns about the use of mesh in prolapse surgeries and limited data is available about mesh complications with laparoscopic lateral suspension. This study aimed to establish the mesh-related complications after laparoscopic lateral suspension. Study Design: We carried out a retrospective analysis of patients who underwent laparoscopic lateral suspension for symptomatic VVP at three tertiary hospitals. Cases were identified from theatre records with coding data and the universities database. Demographic features, concomitant procedures, duration of surgery, intra-operative complications, hospital stay, change in pelvic organ prolapse quantification point C, Patient Global Impression of Improvement scale records, mesh-related complications and their management are presented. Results: A total of 120 patients underwent laparoscopic lateral suspension for symptomatic vault prolapse between 2014-2019. In total, mesh complications developed in 3 women (2.5%). While two vaginal mesh exposures were successfully managed with topical estrogen, one required surgical excision. One lateral mesh arm was loosened from the skin causing pain and itching. From 110 Patient Global Impression of Improvement scores, 106 women (96%) described their prolapse as ‘very much’ or ‘much’ better, 4 patients (3.6 %) reported ‘no change’ and no one reported worsening of symptoms. Conclusions: This series suggests that laparoscopic lateral suspension has low risk of mesh-related complications. It is a safe and effective procedure for symptomatic vault prolapse with high rates of patient satisfaction.

Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study

ObjectiveThe present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). Study designA prospective cohort study on 125 patients with vaginal bulge and apical +/− anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa.The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. Results120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. ConclusionsLLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.