Laparoscopic Sacrocervicopexy Research Articles

Laparoscopic Sacrocervicopexy Using Ethibond Suture Graft: A Very Economic Yet Effective Fertility Preserving Surgery for Pelvic Organ Prolapse.

The modern era has witnessed a transition to a phase of uterus-preserving surgeries and so holds true for pelvic organ prolapse (POP) surgeries as well. Laparoscopic sacrocervicopexy has become a preferred surgical modality for moderate to severe degrees of POP in most women of the childbearing age group. With the alarming incidences of mesh erosion, synthetic mesh has almost gone offthe market. We advocate a very simple and cost-effective technique of laparoscopic sacrocervicopexy using an Ethibond suture graft. It was a pilot prospective observational study over one year. Consecutive consenting women with symptomatic prolapsed uterus Stage-II of the central component of the quantitative POP classification (POP-Q) were recruited. Laparoscopic sacrocervicopexy was performed under general anesthesia using the standard protocols, and patients were prospectively followed for six months after surgery. The duration of surgery and hospital stay were noted. Patient satisfaction was rated using a five-point Likert scale. The vaginal length was measured immediately after and six months post-surgery. Sexual function was assessed using the validated female sexual function index (FSFI) scale six months after sacrocervicopexy. Out of 28 recruited women, the majority were multiparous, highly qualified, and belonged to the middle socio-economic class. Seven patients had co-morbidity in the form of hypertension (17.8%), diabetes (7.1%), and cardiovascular diseases (7.1%). The mean duration of surgery was 105.8±7.2 minutes in the study population. The mean duration of hospital stay was 2.2±0.6 days. No surgical site infection was noted in any of the cases. Most patients rated "very satisfied" experiences following surgery (67.9%). The mean vaginal length after surgery was 7.6±1.2 centimeters. After a follow-up period of six months, the mean vaginal length was 7.4±0.8 centimeters. The mean FSFI score was 30.8±2.4. Laparoscopic sacrocervicopexy with Ethibond suture graft is a cost-effective and safe surgical technique for POP in resource-limited settings. It also obviates the additional cost of synthetic mesh and the long-term risks of mesh erosion.

Comparison of Different Laparoscopic Sacropexy Procedures for Advanced Uterine Prolapse: A Retrospective Analysis

To compare the long-term outcomes and complications of 3 different variants of laparoscopic sacropexy. Single-center retrospective cohort study. A tertiary university hospital. A total of 483 patients with advanced uterine prolapse who underwent laparoscopic sacrohysteropexy (LSH), laparoscopic supracervical hysterectomy with concomitant laparoscopic sacrocervicopexy (LSCH+LSC), or total laparoscopic hysterectomy with concomitant laparoscopic sacrocolpopexy (TLH+LSC). Demographic data, Pelvic Organ Prolapse Quantification scores, questionnaire results, surgical conditions, postoperative outcomes, and complications were all extracted from medical and follow-up records. Between April 2012 and December 2020, 277 women underwent LSH, 95 women underwent LSCH+LSC, and 111 women underwent TLH+LSC. LSH procedures were associated with statistically significantly least blood loss and least postoperative hospital days and catheterization days (all p <.001). During the median follow-up of 32 months (13-117 months), analysis of the data revealed notable anatomic correction in all groups regarding Pelvic Organ Prolapse Quantification measurements (p <.001), and the anatomic cure rate showed no significant difference among these 3 groups (p=.273). No statistically significant differences were detected for prolapse recurrence (p=.171) and functional improvements among these groups. Neither intraoperative injuries (p=.098) nor total postoperative complications (p=.218) differed considerably, whereas the rate of severe postoperative complications (p <.001) including mesh exposure (p=.004) was significantly higher in the TLH+LSC group than that in the other groups. LSH is the appropriate choice for women with uterine prolapse without contraindications for uterine preservation. For patients with benign uterine lesions and a normal cervix, LSCH+LSC is a safer approach that provides similar anatomic results and improved quality of life scores that are similar to those of TLH+LSC. For patients with lesions in the uterus and cervix, TLH+LSC should be selected.

Laparoscopic Sacrocervicopexy for Uterovaginal Prolapse: Step by Step for Safety and Efficiency

<h3>Study Objective</h3> The purpose of this video is to demonstrate the step by step of laparoscopic sacrocervicopexy for uterovaginal prolapse using a Y-shaped monofilament polypropylene mesh. <h3>Design</h3> Laparoscopic Subtotal hysterectomy is performed. After that, opening of the posterior peritoneum took place on the sacral promontory and was extended under the right uterosacral ligament. The Douglas pouch was then opened, and the rectovaginal plane was exposed. This maneuver was facilitated by the introduction and the relevant movements of a vaginal malleable valve. Dissecting the inter vesicovaginal space, the anterior mesh is on the anterior vaginal apex with two other sutures and the anterior mesh was fixed on the anterior vaginal wall just before the trigone and at the isthmus of the uterus. After that, the posterior mesh was fixed on the posterior vaginal apex with two other sutures and on the posterior vaginal wall. Both sutures with a 2/0 polygalactin suture. Mesh were anchored on the sacral promontory using a 0 polypropylene non absorbable suture on the longitudinal ligament. At the end, full peritonization of the mesh with a 2–0 polyglactin running suture. <h3>Setting</h3> Patient positioned in a Trendelenburg lithotomy position with legs slightly bent. A 10-mm trocar was placed at the umbilicus, two 5-mm trocars were positioned 2 cm above and medially to the anterior superior iliac spine and a third was positioned midway between the umbilicus and the pubic symphysis. <h3>Patients or Participants</h3> One 56 years old female patient with uterovaginal prolapse stage IV. <h3>Interventions</h3> laparoscopic sacrocervicopexy for uterovaginal prolapse with Y-shaped monofilament macroporous polypropylene mesh. <h3>Measurements and Main Results</h3> The laparoscopic sacrocervicopexy can be performed in patient at stage IV uterovaginal prolapse after partial hysterectomy in an efficient way. After the laparoscopic sacrocervicopexy surgery, the patient evolved with correction of the prolapse to stage I. <h3>Conclusion</h3> Laparoscopic surgery allows a good view of the vaginal walls performing this procedure safely and efficiently

Evaluation of the Pubocervical Fascia With 3-Dimensional Endovaginal Ultrasonography and Correlation With Intraoperative Findings During Robotic Sacrocervicopexy

To evaluate the pubocervical fascia (PF) in patients with pelvic organ prolapse (POP) using 3-dimensonal endovaginal ultrasonography (EVUS) and to correlate the PF appearance with both pelvic examination and intraoperative findings during ultrasonographic robotic-assisted laparoscopic sacrocervicopexy and pubocervical fascia reconstruction (u-RALS-PFR). A retrospective analysis was performed in 120 women with symptomatic POP. Preoperative evaluation was done using EVUS. We identified areas of PF weakness based on pelvic examination as hypoechoic and hyperechoic defects (HHD) between the bladder and vagina. Study measurements included distance from the HHD to the pubic symphysis, HHD to the bladder neck, HHD to the posterior bladder wall, and hypoechoic-hyperechoic area. We correlated these metrics with the respective POP-Q stages and findings during u-RALS-PFR. Using the quantitative measures during EVUS, we found a significant association between mean HHD (2.7 cm) and POP-Q stage III, and between HHD and number of plications performed during surgery. The larger the HHD, the more severe the POP-Q stage of the anterior compartment of the vaginal wall; thus, more plications were performed on the PF (7-12 plications) during robotic sacrocervicopexy, and consequently the anterior arm of the Y-mesh was significantly trimmed (6-8 cm). HHD obtained by EVUS was associated with severe POP-Q stage III and seemed to correlate with the number of plications during robotic sacrocervicopexy. Performing these plications on the PF significantly decreased the length of the anterior vaginal mesh needed for the procedure. These findings may open new applications for preoperative ultrasonography in evaluation and treatment of patients with apical and anterior POP.

Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study)

BackgroundAbdominal and laparoscopic sacro-colpopexy (LSC) is considered the standard surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH + LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH + LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures.MethodsA retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH versus either LSCH + LSC or TLH + LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic.ResultsIn total, 294 women were included in this analysis (LSH n = 43, LSCH + LSC n = 208 and TLH + LSC n = 43). There were no differences in the incidence of perioperative injuries and complications. There were no statistically significant differences between the concomitant hysterectomy and the uterine sparing groups in any of the operative, clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p = 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006).ConclusionLSH seems to be associated with higher incidence of anterior compartment failures and suboptimal mesh placement based on postoperative imaging techniques compared to LSC with concomitant hysterectomy.

Ultrasonography and robotic-assisted laparoscopic sacrocervicopexy with pubocervical fascia reconstruction: comparison with standard technique.

The objective of this study was to evaluate our technique of ultrasonography and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) versus standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) in the treatment of patients with symptomatic apical/anterior vaginal prolapse. A retrospective analysis was done using the data in two community hospitals. Thirty women presented with symptomatic vaginal apical prolapse and desired minimally invasive surgery (video): (a) standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) (n = 15) or (b) ultrasound and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) (n = 15) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative staging. There was longer operating room time in the u-RALS-PFR group compared with the s-RALS group (average difference 35min); however, sacral promontory dissection time was less in the u-RALS-PFR (average difference of 15min). The anterior/posterior vaginal dissection and mesh tensioning time was longer in the u-RALS-PFR, as expected. There was only one surgical and anatomic failure (7%) in the s-RALS group after 6months of surgery (POP Q = Aa + 1, Ba0, Ap-2, Bp-3, C-7). Our technique of ultrasonography and pubocervical fascia reconstruction during RALS appears to be feasible and safe. It aims to improve anterior and apical support, minimize the use of mesh and improve visualization during surgery. u-RALS-PFR approach will add some additional time during surgery but may provide better outcomes.

Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report

BackgroundIatrogenic endometriosis is the presence of endometrial glands and stroma out of the uterus following certain surgical interventions. The rate of iatrogenic endometriosis after gynecologic surgeries due to benign uterine disease is 1–2%. Laparoscopic supracervical hysterectomy is also a part of frequently used surgical treatment of apical pelvic organ prolapse, which is followed by sacrocervicopexy. However, there are no data about iatrogenic endometriosis after apical prolapse surgery in the current literature. Herein, we present a case report of a patient diagnosed with de novo endometriosis 1 year after laparoscopic supracervical hysterectomy and sacrocervicopexy.Case presentationA 46-year-old parous Slavic woman who underwent laparoscopic supracervical hysterectomy and sacrocervicopexy secondary to grade 3 symptomatic apical prolapse 1 year earlier was admitted to the same clinic with pelvic pain that had started 6 months following surgery. Deep vaginal palpation was painful. Transvaginal ultrasonography revealed an area with hypervascularization on the sacral promontory. She was scheduled for diagnostic laparoscopy. A 2 × 2-cm solid, wine-colored, hypervascular hemorrhagic lesion was seen on the sacral promontory. The lesion and the peritoneal layer behind it were totally excised. The patient was discharged on the first postoperative day, without any complications. Pathologic examination revealed foci of endometriosis comprising endometrial glands and stroma within the connective tissue, along with hemosiderin-laden macrophages. The symptoms of the patient resolved after the surgery, and no further adjuvant treatment was needed.ConclusionAlthough the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.

Vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC): technique and mean 20 months outcomes

Vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC): technique and mean 20 months outcomes

A laparoscopic procedure for the treatment of uterine prolapse during pregnancy: A case series

ObjectiveTo demonstrate the outcomes of pregnancies with uterine prolapse who have undergone laparoscopic suspension via a new approach during the first and second trimesters. DesignRetrospective case series study. PatientsThree patients who had undergone surgical procedures for uterine prolapse during pregnancy. InterventionsLaparoscopic treatment of uterine prolapse involves a procedure called ‘vaginal assisted laparoscopic sacrocervicopexy’. The complications and difficulties of each case are described. ResultsThe patients underwent surgical procedures at 12, 14 and 16 weeks of pregnancy. All cases were delivered at term. As the gestational age increased, the operation became more difficult and the operation time was prolonged. The patient who delivered vaginally was complicated with shoulder dystocia. ConclusionThree successful cases of uterine prolapse surgery during pregnancy are reported. Surgery can be performed during pregnancy if absolutely necessary, and does not need to be delayed until the postpartum period.

Single-port versus multi-port robotic sacrocervicopexy: Establishment of a learning curve and short-term outcomes

ObjectivesThe purpose of this study was to compare the learning curves, surgical outcomes and complications of multi-port access robotic-assisted laparoscopic sacrocervicopexy (MP-RSC) to single-port robotic access (SP-RSC) for vaginal apex prolapse. MethodsA retrospective study of the first 52 MP-RSC procedures compared with the first 52 SP-RSC procedures performed at one medical center. Primary outcomes were intraoperative bleeding, operative time, and hospitalization. Secondary outcomes were surgical complications. ResultsThere was a statistically significant difference in mean operative times between the MP-RSC and SP-RSC procedures: 206.5 ± 39.4 and 187.8 ± 46.2, respectively, P = 0.028. The mean estimated intraoperative blood loss was 35 [20–87.5] ml and 20 [10–47.5] ml, respectively, P = 0.008. Respective mean operative times decreased from the first 15 to the subsequent 15 cases: in the MP-RSC group from 224.2 ± 43.2 to 198.4 ± 36.3 min, P = 0.088, and in the SP-RSC group from 222.4 ± 53.1 to 161.3 ± 28.2 min, P < 0.001. The subsequent 22 cases showed different trends. Hospitalization (days) and level of pain at 24 h postoperative, according to a 1–10 point visual analogue scale, did not differ. Adverse events were rare in both groups. ConclusionsMP-RSC and SP-RSC are feasible and the short term outcomes and learning curves for both procedures are comparable.

47: Power morcellation in laparoscopic sacrocervicopexy with supracervical hysterectomy: a retrospective review of uterine pathology

To review uterine pathology of patients undergoing laparoscopic supracervical hysterectomy with electromechanical (power) uterine morcellation and sacrocervicopexy for uterovaginal prolapse. This retrospective cohort study used the electronic medical record to review the cases of 182 patients undergoing laparoscopic supracervical hysterectomy with uterine power morcellation and sacrocervicopexy performed by a single high-volume gynecologic surgeon at our institution between January 1, 2012 and December 31, 2017. Uterovaginal prolapse was the primary indication for surgery for all patients included. The electronic medical record was reviewed to determine demographic and operative variables, pathology reports, and any post-operative complications. Of the 182 patients undergoing this procedure, the mean age was 63.4 years (standard deviation: 9.73). 5.0% had a post-operative complication (3 with incisional cellulitis, 3 with trocar incision site herniation, 1 with urinary retention requiring an emergency department visit, 1 with severe constipation requiring disimpaction, and 1 with perforation of the cecum from a concurrent rectopexy performed by colorectal surgery requiring re-operation). No patient had a complication directly related to uterine power morcellation or uterine pathology. The median uterine mass was 55.5 grams (interquartile range: 38.8 - 81.0). 49.9% of patients had leiomyomas noted in the pathology report, 40.7% had adenomyosis, 11.5% had uterine polyps, and 4.4% had endometrial hyperplasia (4 with simple hyperplasia without atypia, 1 with simple hyperplasia with focal atypia, 1 with complex hyperplasia without atypia, and 1 with complex hyperplasia with focal atypia). None of the patients with endometrial hyperplasia had reported abnormal uterine or postmenopausal bleeding and as such had not had endometrial sampling prior to surgery. 100% of patients had at least one follow up visit with the surgeon. While there has been extensive examination of the use of uterine power morcellation in benign minimally invasive hysterectomy, there is minimal data specifically focusing on its use for patients whose primary indication for hysterectomy is uterovaginal prolapse. While our sample is limited to a single institution, our data suggests that malignant pathology may be even rarer than that found in hysterectomy for other benign indications. These variations should be considered when making decisions about the use of uterine power morcellation.

A Unique Case of Rectosigmoid Mesh Erosion Presenting as Left Thigh Sinus Tract Abscess Following Laparoscopic Sacrocervicopexy

Background: Mesh erosion is a well-known complication after use of mesh for pelvic organ prolapse repair. The most common site of mesh erosion is the vagina. Nonvaginal mesh erosions into bowel and bladder are rare. Mesh erosion into the bowel can be a devastating complication with significant morbidity and could need multiple surgeries for repair and recovery. Mesh erosion presenting as thigh sinus-tract abscess is unusual and rare. Case: A 41-year-old female had rectosigmoid mesh erosion after laparoscopic sacrocervicopexy; this condition presented with a recurrent left sinus-tract thigh abscess. Rectosigmoid mesh erosion, with a thigh sinus-tract abscess was suspected on the basis of local and pelvic examination findings as well as ultrasonography findings. This case was managed by excision of the mesh with closure of the sinus tract, and bowel diversion and repair. Results: This patient was asymptomatic after 3 years of follow-up. Conclusions: Total excision of the mesh with repair of the bowel defect seems to be an appropriate treatment for patients with mesh eroding into the bowel. Sometimes bowel diversion (ileostomy or colostomy) is needed. Any unusual anorectal or gynecologic symptom should alarm the physician, and the possibility of mesh erosion should be suspected.

Surgical Outcomes of Laparoscopic Mesh-Less Sacrocervicopexy for Central Compartment Prolapse

Surgical Outcomes of Laparoscopic Mesh-Less Sacrocervicopexy for Central Compartment Prolapse

Should we use visual entry techniques in patients with previous laparotomies?

Laparoscopic surgery has become the method of choice for treating an ever increasing number of gynaecological disorders that require surgery. However, primary port insertion is a potentially dangerous step especially in patients with previous laparotomies. The aim of this study is to identify whether visual entry technique has any advantage over the closed one in patients with previous laparotomies. This is a retrospective observational case control study of 2541 patients with previous laparotomies who underwent laparoscopic surgery from January 1992 to September 2003 at Vijaya Hospital, Kochi and from October 2003 to October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, India. The control group comprised of 1261 patients, operated between January 1992 and September 2003 at Vijaya Hospital, Kochi, in whom closed technique of abdominal access for primary port creation was used. The study group comprised of 1280 patients, operated between October 2003 and October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, in whom visual entry (EndoTIP) was used for primary port creation. Procedures included in both groups were total laparoscopic hysterectomy, laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic conservative surgery, laparoscopic tubal reanastomosis, laparoscopic sacrocolpopexy, laparoscopic sacrocervicopexy, laparoscopic adhesiolysis and laparoscopic sterilisation. There was no evidence of intestinal or vascular injury during visual entry using a blunt EndoTIP cannula. There were three cases of bowel injury with the closed, blind entry technique using a sharp linear trocar in the control group. The p value (Chi-square test) is 0.04, which is statistically significant. Visual entry, as an approach to abdominal access in patients with previous laparotomies, wherein chances of encountering peritoneal and bowel adhesions are very high, is safer than the closed blind entry technique in preventing bowel injuries.

The effectiveness of two different laparoscopic surgeries for apical support of pelvic organ prolapse

ObjectiveTo evaluate the efficacy of laparoscopic colpo-uterine butterfly suspension and compare it to laparoscopic sacrocervicopexy for apical support in sexually active patients of pelvic organ prolapse. Study designTwenty-there women with symptomatic prolapse of apical prolapse underwent laparoscopic colpo-uterine butterfly suspension and forty-five underwent laparoscopic sacrocervicopexy at the first affiliated of Zhengzhou University between January 2010 and June 2013.They all presented with at least a stage 2 apical prolapse. Pre- and post-operative data referring to pelvic organ prolapse quantification (POP-Q) system were compared. At the same time, validated questionnaire of the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12) were included. ResultsFrom 2010 to 2013, 68 patients were included. Only 3 cases lost the follow-up in the Laparoscopic sacrocervicopexy. In the laparoscopic colpo-uterine butterfly suspension, there was no recurrence versus in five the laparoscopic sacrocervicopexy. When considered the operating time and blood loss, the laparoscopic colpo-uterine butterfly suspension was more favorable. Erosion was higher in the laparoscopic sacrocervicopexy compared to the other group (0% vs 21.4%). There was no difference in the postoperative PFDI-20 score (P=0.3079), and PFIQ-7 score (P=0.8889) between the two groups, while the PISQ-12 score was much higher in the laparoscopic colpo-uterine butterfly suspension than the other group (P=0.0076). ConclusionLaparoscopic colpo-uterine butterfly suspension is a more effective option for sexually active women with pelvic organ prolapse.

A review on the role of laparoscopic sacrocervicopexy.

To provide an update on the outcomes and complications of laparoscopic (or robot-assisted) sacrocervicopexy with and without supracervical hysterectomy, and highlight the differences with sacrocolpopexy technique based on the most recent evidence. Laparoscopic and robot-assisted sacrocervicopexy with supracervical hysterectomy and sacrohysteropexy have good success rates, with a mean objective success rate of 96% (range 90-100%), subjective success rates of 80-95% and mean reoperation rate of 3%. Also, pelvic symptoms and quality of life improved after laparoscopic sacrocervicopexy. These results are similar to laparoscopic and abdominal sacrocolpopexy, and are confirmed by the results of two comparative studies. Mesh erosion risk is very low in patients treated with laparoscopic sacrocervicopexy. Studies that compare laparoscopic sacrocolpopexy with concomitant total hysterectomy and sacrocervicopexy with subtotal hysterectomy show that total hysterectomy is associated with a greater prevalence of vaginal mesh exposure when compared with a subtotal hysterectomy. In case of sacralpexy, if it is decided to proceed with a hysterectomy, it is recommended to limit this to a subtotal. The benefits of laparoscopic sacrocervicopexy with or without supracervical hysterectomy in terms of outcomes and reduced risk of mesh erosion in comparison with sacrocolpopexy and concomitant total hysterectomy have to be confirmed by randomized controlled trials. Moreover, standardization of surgical technique is mandatory.

Vaginal Trachelectomy Following Laparoscopic Supracervical Hysterectomy and Sacrocervicopexy

Current evidence supports cervical preservation at the time of abdominal prolapse repair using synthetic mesh to minimize vaginal mesh extrusion. This report aims to describe management of benign cervical disease following laparoscopic sacrocervicopexy including successful trachelectomy performed vaginally. A 70-year-old sexually active woman presented with symptomatic pelvic organ prolapse and stress urinary incontinence. Her Papanicolaou smears over several years were unremarkable, and she had a benign endocervical polyp removed in the office 3 months before surgery. She underwent an uncomplicated robotic-assisted laparoscopic supracervical hysterectomy and sacrocervicopexy. She presented 8 months after surgery with persistent vaginal spotting after intercourse and was found to have a recurrent endocervical polyp. Ultimately, she underwent uncomplicated trachelectomy performed vaginally with resolution of her symptoms. Retention of the cervix at the time of mesh-augmented abdominal prolapse repairs introduces a unique set of evaluation and management considerations for benign cervical disease. Trachelectomy performed vaginally was successful and uncomplicated in this case.

Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse

To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define "surgical failure" as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.

Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation and Sacrocervicopexy: Initial Experience With a Novel Surgical Approach to Uterovaginal Prolapse

The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse in 43 patients was evaluated and surgically treated using this novel procedure. Preoperative assessment included pelvic examination, the pelvic organ prolapse quantification scoring system (POP-Q), and complex urodynamic testing with prolapse reduction to evaluate for symptomatic or occult stress urinary incontinence. The surgical procedure consisted of laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy with anterior and posterior mesh extension. Concomitant procedures were performed as indicated. All procedures were completed laparoscopically using only 5-mm abdominal port sites, with no intraoperative complications. Patients were followed up postoperatively for pelvic examination and POP-Q at 6 weeks, 6 months, and 12 months. The median (interquartile range) preoperative POP-Q values for point Aa was 0 (−1.0 to 1.0), and for point C was −1.0 (−3.0 to 2.0). Postoperatively, median points Aa and C were significantly improved at 6 weeks, 6 months, and 12 months (all p < .001). One patient was found to have a mesh/suture exposure from the sacrocervicopexy, which was managed conservatively without surgery. We conclude that laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy is a safe and feasible surgical approach to treatment of uterovaginal prolapse, with excellent anatomic results at 6 weeks, 6 months, and 12 months. Potential advantages of the procedure include minimizing laparoscopic port site size, decreasing the rate of mesh exposure compared with other published data, and reducing the rate of postoperative cyclic bleeding in premenopausal women by removing the cervical core. Longer follow-up is needed to determine the durability and potential long-term sequelae of the procedure.

An Unusual Case of Mesh Erosion Following Laparoscopic Sacrocervicopexy

To present a unique case of mesh complication following laparoscopic sacrocervicopexy and discuss the prevalence of mesh erosion in laparoscopic procedures performed for pelvic organ prolapse. Case Report. Major Academic Center. 55yo G3P2012 presents with vaginal discharge 10 months following an uncomplicated laparoscopic supracervical hysterectomy and sacrocervicopexy with anterior and posterior colporrhaphy for symptomatic pelvic organ prolapse. She was maintained on vaginal estrogen for atrophy. Multiple examinations of the vagina revealed only grayish discharge without evidence of mesh. Imaging did not reveal a fistula. Vaginoscopy under anesthesia demonstrated mesh at the prior junction of the endocervix and lower uterine segment. Patient underwent laparoscopic mesh excision with trachelectomy. Mesh was visualized protruding through internal cervical os. Chronic inflammation was noted around mesh erosion, however no abscess or purulence was appreciated. Uterosacral ligament suspension was performed for reinforced vault suspension. Pathology revealed cervical mucosal ulceration with acute and chronic inflammation, and foreign body giant cell reaction to mesh material. Erosion is a known complication of procedures using synthetic mesh for pelvic organ or vault suspension. Concurrent hysterectomy with mesh suspension procedure is a risk factor for erosion, however, rates in the literature are higher with total hysterectomy compared to supracervical hysterectomy. Bacterial infection or devascularization of tissue are thought to contribute to erosion risk. The in situ cervix maintains vascularization, is a barrier to vaginal flora and requires less mesh for suspension. In this case, migration of the mesh into the cervical os resulted in chronic inflammation and impaired healing, presenting as vaginal discharge. Despite use of the cervix as an additional barrier, mesh erosion may still occur in patients undergoing laparoscopic sacrocervicopexy. This unusual presentation highlights the importance of vigilance regarding prevention and management of mesh-related events.