Laparoscopic Sacrocolpopexy Research Articles

A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR.

Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. Although the overall rate of sexually active women and sexual desire declined 12months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.

Postoperative complications and unanticipated healthcare encounters following mini-laparotomy vs. laparoscopic/robotic-assisted sacrocolpopexy: a comparative retrospective study

BackgroundPelvic organ prolapse is a debilitating condition impacting lives of millions of women worldwide. Sacrocolpopexy (SCP) is considered an effective and durable surgical technique for treatment of apical prolapse. The aim of this study was to compare short-term outcomes including postoperative complications and unanticipated healthcare encounters between patients who underwent SCP with a mini-laparotomy approach compared to patients treated with laparoscopic and robotic-assisted laparoscopic SCP.MethodsThis was a retrospective cohort study including patients treated for apical prolapse at a university affiliated urogynecology practice. Patients over the age of 18 who underwent abdominal SCP between 2019 and 2023 were included. The cohort was formed into two groups: (1) Patients who underwent SCP through a mini-laparotomy incision (Mini-lap group); (2) Patients who underwent laparoscopic or robotic-assisted laparoscopic SCP (Lap/Robot group).ResultsA total of 116 patients were included in the final analysis. Ninety patients underwent either laparoscopic or robotic-assisted SCP, whereas 26 patients underwent SCP with a mini-laparotomy approach. Study participants exhibited a mean age of 63.1 ± 10.3 years, mean body mass index (BMI) of 25.8 ± 4.9 Kg/m2, and 77.6% of them identified as Caucasian. Upon comparison of demographic and past medical history between groups there were no statistically significant differences in age, BMI, menopausal status, race, parity or comorbid conditions. Patients in the Mini-lap group were less likely to have undergone previous abdominal surgery (11.5% vs. 50.6%, p < 0.001) and had more severe apical prolapse (stage 4 prolapse, 40% vs. 21.2%, p < 0.001) than their counterparts in the Lap/robot group. Regarding intraoperative parameters, length of surgery was significantly shorter in the Mini-lap group compared to the Lap/robot group (97.3 ± 35.0 min vs. 242.0 ± 52.6 min, p < 0.001). When focusing on the primary outcome, postoperative complications within the first 30 days after surgery, there were no differences noted between groups. Additionally, the number of unanticipated healthcare encounters, such as phone calls, clinic visits, emergency department visits, urgent care visits, readmissions and reoperations were similar between groups.ConclusionsMini-laparotomy approach for SCP is safe with comparable intra- and postoperative complications, and unanticipated healthcare encounters compared to conventional minimally invasive methods.

Recurrent Pelvic Organ Prolapse after Sacrocolpopexy-A Surgical Challenge.

Background: Repeat sacrocolpopexy (reSCP) for recurrent pelvic organ prolapse (POP) is a rare and complex condition with little understanding of how to manage. Most authors recommend complete reSCP regardless of the underlying cause of the failure. This retrospective cohort study presents our management workflow and how to systematically approach this challenging situation. Methods: From 2017 to 2021, we analyzed all women undergoing surgery for recurrent POP after sacrocolpopexy at our tertiary referral hospital at the department of urogynecology. Preoperatively, all women underwent a structured work-up consisting of answering the validated German female pelvic floor questionnaires, a clinical examination utilizing the POP-Q staging system according to the International Continence Society (ICS), and a pelvic floor ultrasound. The surgical management was based on the preoperative findings and was adapted individually during surgery if indicated according to the estimated underlying problem for recurrence. Results: In total, 377 women underwent a primary laparoscopic sacrocolpopexy. However, ten women presented with a symptomatic recurrent prolapse requiring further surgical intervention. A reSCP was performed in eight women, including two with additional laparoscopic paravaginal repair to correct the displaced mesh placement at initial surgery. A vaginal correction was indicated in two women with an isolated posterior compartment prolapse. The analysis demonstrates that reSCP has a low intraoperative complication rate and high subjective and objective success rates. Conclusions: We could demonstrate that individualized reSCP after initial SCP is a challenging yet feasible and safe treatment option, but there may be suitable alternatives. If women undergo pre- and intraoperative standardized problem-oriented examinations, we can often identify the cause of the recurrent prolapse. Tailored surgery must be subsequently performed.

Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series.

Background Vaginal erosion caused by the polypropylene mesh is a serious side effect, and the development of effective treatment methods is required. This study explored the potential of non-ablative vaginal erbiumyttrium aluminum garnet (YAG) laser treatment (VEL) as a novel treatment approach. Methods In this study, VEL was performed on nine women who experienced vaginal erosion after undergoing treatment for pelvic organ prolapse (POP) with polypropylene mesh. These patients visited our hospital between April and December 2020. Using the Renovalase (SP Dynamis Fotona d.o.o., Ljubljana, Slovenia), the laser was applied to the entire vagina, with intensive irradiation focused on the erosion areas. Detailed analyses of symptoms before and after treatment, as well as histopathological changes, were conducted one year post-treatment. Results Nine women were referred to our hospital due to vaginal erosion caused by polypropylene mesh. The participants' average age was 73.2 years (range: 69-81 years), with four patients having undergone transvaginal mesh (TVM) surgery and five undergoing laparoscopic sacrocolpopexy (LSC). The average time from mesh insertion to treatment initiation was 7.2 years (range: 3-15 years), with eight patients having previously attempted mesh removal. Post-treatment, significant improvements were observed in managing vaginal erosion and related bleeding, corroborated by histopathological analysis confirming cell regeneration and tissue repair. These improvements also resulted in significant improvements in bleeding management and quality of life (QoL). Conclusion VEL suggests the possibility of being an effective treatment method for vaginal erosion caused by a polypropylene mesh. However, further research is needed because of the small sample size and the limitations inherent in the retrospective case series design.

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.

Importance of vaginal packing after laparoscopic sacrocolpopexy - retrospective study.

To compare the subjective and objective results of laparoscopic sacrocolpopexy (LSC) with and without the introduction of a vaginal packing one year after surgery.Methodology:This is a retrospective cohort study of 125 women after laparoscopic sacrocolpopexy operated on in 2013-2016 with complete annual follow-up. Patients with a total hysterectomy were excluded from the study. Basic patient characteristics, preoperative POP-Q and surgery data were collected. The subjectiveoutcome of the surgery was assessed using the PGI-I (patient global impression of improvement). The anatomicoutcome of the surgery was evaluated using the composite definition of surgical failure based on POP-Q (Ba ≥ -1, C ≥ -3, Bp ≥ -1). Patients were divided into two groups according to whether or not they had vaginal packing after surgery. Statistical analysis was performed usingc2, Wilcoxon and Fischer test according to the distribution of normality.Results:A total of 125 women were enrolled in the study; 48 (38.4%) after LSC, 58 (46.4%) with concomitant supracervical hysterectomy and 19 (15.2%) after sacrohysterocolpopexy. Vaginal packing was introduced for 24-48 hours after surgery in 86 (68.8%) women. The groups did not differ in age, body mass index, smoking or preoperative pelvic organ prolapse quantification system. We did not observe statistically significant differences in PGI-I first year after surgery. The difference in anatomic surgical failure did not reach statistical significance, although more failures were observed in the group without packing (12.8 vs. 3.5%; P = 0.09). The mean C-point value one year after surgery was lower in the non-tamponade group (-7 vs. -7.5; P &lt; 0.009). No mesh extrusion or serious complications were recorded in the monitored group.Conclusion:Vaginal packing after LSC probably does not affect patient satisfaction after surgery, however, it may be associated with better anatomicaloutcome one year after the surgery. The results of the study must be confirmed by a more detailed prospective evaluation.

Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy

Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.

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.

Comparison of Surgical Outcome of Laparoscopic Sacrocolpopexy between the Novice and Experienced Surgeon in Laparoscopic Surgery

We retrospectively analyzed the safety and surgical outcomes of laparoscopic sacrocolpopexy (LSC) by the novice surgeon (performed ＜5 laparoscopic surgery). Between November 2017 and December 2020, there were 15 cases in which the novice surgeon performed part of LSC, 8 cases in which the novice performed all of LSC, and 50 cases in which the experienced surgeon (performed ＞100 laparoscopic surgery) performed all of LSC. We compared surgical outcome of the 50 cases operated by the experienced surgeon and 23 cases operated by the novice. The laparoscopic time was longer when performed by the novice than by the experienced surgeon (median 208 minutes vs 189 minutes, p＝0.039). Cases of pelvic organ prolapse quantification system (POP-Q) stage 4 were operated more often by the experienced surgeon than by the novice (28% vs 4.8%, p＝0.027). There were no significant differences in the complications and recurrence of pelvic organ prolapse (POP-Q≧2). The LSC process was divided into five steps. The laparoscopic time of all steps was longer when performed by the novice than by the experienced surgeon except the step of lifting up the sigmoid colon and hysterectomy. As the number of cases performed by the novice increased, the laparoscopic time of all steps decreased. The short-term surgical outcomes for cases operated by the novice and experienced surgeon were comparable when the novice avoided cases of POP-Q stage 4. LSC has been said to be difficult, but in this study, even novice surgeons in laparoscopic surgery may be able to perform LSC by accumulating cases. Although this study is not generalizable due to limitations, we believe it will inspire many young doctors to perform LSC.

Robotic sacrocolpopexy.

Pelvic organ prolapse (POP) is a common cause of gynecological disease in elderly women. The prevalence of POP has increased with an aging society. Abdominal sacrocolpopexy (ASC) is safer and more effective than the vaginal approach in patients with apical compartment POP because it has a higher anatomical cure rate, a lower recurrence rate, less dyspareunia, and improved sexual function. Laparoscopic sacrocolpopexy (LSC) has replaced ASC. Robotic sacrocolpopexy (RSC) also helps overcome the challenges of LSC by facilitating deep pelvic dissection and multiple intracorporeal suturing. The RSC is technically easy to apply, has a steep learning curve, and offers many advantages over the LSC. However, insufficient data led us to conclude that the LSC is superior overall, especially in terms of costeffectiveness. The present review provides insights into different aspects of RSC, highlighting the most common benefits and concerns of this procedure. We searched for eligible articles discussing this issue from January 2019 to March 2022 to reveal the outcomes of RSC.

Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons' initial experience.

To introduce a novel technique of transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy (ESLS) for apical prolapse and to evaluate the feasibility and short-term outcomes of this technique. Sixteen patients were enrolled to undergo ESLS between January 2020 and May 2021. Perioperative outcomes were included. Short-term results were assessed by Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Organ Prolapse Quantification (POP-Q) scores, mesh exposure and prolapse recurrence. A total of 14/16 cases (87.5%) were successfully completed. The mean operation time was 118min (range 85-160), and the mean blood loss was 68ml (range 20-100). The mean postoperative visual analog scale (VAS) pain score at 24h was 0.7. No intraoperative complications occurred except for one patient who developed subcutaneous emphysema. All patients gained a significant improvement in both physical prolapse and quality of life at 12 months after surgery, and there was no mesh exposure or prolapse recurrence. Our experience showed that transvaginal ESLS is a feasible and effective technique for apical prolapse with a previous hysterectomy. However, this technique should be performed by surgeons with extensive experience both in vaginal surgery and laparoscopic single-port surgery.

Evaluation of Long-Term Sexual Satisfaction in Women Submitted to Laparoscopic Sacrocolpopexy: Retrospective Tertiary Center Study

Introduction: Traditional treatments for apical compartment prolapse and multicompartment prolapse, such as open sacrocolpopexy, have been associated with concerns regarding sexual function. In recent years, laparoscopic or robotically assisted sacrocolpopexy has emerged as an alternative with potential benefits, including enhanced visualization, symptom relief, and comparable anatomical results. However, the impact of laparoscopic sacrocolpopexy (LSP) on long-term sexual satisfaction in women remains an important area of investigation. This retrospective tertiary center study aimed to evaluate the long-term sexual satisfaction in women who underwent LSP for the treatment of POP. The objective was to assess postoperative sexual satisfaction among patients with a history of active sexual life before the surgery. Methods: A total of 30 patients who underwent laparoscopic sacrocolpopexy between August 2014 and December 2016 were included in the analysis. The patients’ sexual satisfaction was assessed using The New Sexual Satisfaction Scale, a validated questionnaire in the Portuguese language with a mean follow-up of 7 years. Baseline characteristics, surgical and function outcomes were also evaluated. Results: Among the participants, 70% remained sexually active after the surgery. The mean score on The New Sexual Satisfaction Scale was 75.1, indicating a moderate to very satisfied level of sexual satisfaction. Out of the patients who reported a change in their sexual satisfaction after surgery, 69.2% would still recommend the procedure to others. The mean rate of global satisfaction with the surgery was 6.97 out of 10, with 83.3% of the patients recommending the surgery to someone else. Conclusion: The study provides valuable insights into the impact of laparoscopic sacrocolpopexy on sexual well-being in women with POP. Despite potential changes in sexual function, the majority of patients remained sexually active and perceived the procedure as beneficial, expressing overall satisfaction and recommending it to others. The findings highlight the importance of considering sexual function in the management of POP and suggest that LSP can be an effective treatment option that preserves sexual activity. However, further studies with larger sample sizes and comprehensive assessments are warranted to better understand the complex relationship between pelvic organ prolapse surgery, sexual function, and patient outcomes.

Методы коррекции сочетанных форм генитального пролапса лапароскопическим доступом

Aim: to evaluate the efficacy and safety of a combined technique — pectopexy, and the most common — laparoscopic sacrocolpopexy for pelvic organ prolapse correction. Patients and Methods: the study included 32 female patients with a similar nosological form of pelvic organ prolapse. All the subjects were divided into two groups depending on the surgical treatment method. Group 1 (main group) included 14 female patients who had a combined laparoscopic correction of pelvic organ prolapse with transverse and longitudinal fixation of synthetic implants — combined pectopexy. Group 2 (control group) included 18 female patients who underwent sacrocolpopexy. Comprehensive clinical and instrumental examination of female patients was performed before and within 24 months after surgery. Results: there were no intraoperative complications in female patients of both groups. In all cases, the surgical intervention result was recognized as positive both according to the patient assessment and medical researcher assessment. There was a significant improvement in indicators reflecting the central compartment condition (apical prolapse), as well as the anterior and posterior vaginal walls. All female patients showed an improvement in their life quality. The patients also showed positive tendency according to pelvic ultrasound after surgery. No pelvic mesh complications were reported. The parameters of the Pelvic Organ Prolapse Quantification (POP-Q) system assessment did not differ significantly in female patients from both groups 1, 6, 12 and 24 months of follow-up after surgery. Conclusion: based on the obtained follow-up data, correction of central, posterior and partially anterior prolapse was achieved in patients after combined transverse and longitudinal fixation of synthetic implants. Pectopexy is safe and comparable to sacrocolpopexy, which is currently considered the most common surgery, gives a positive effect in correcting pelvic organ prolapse and improves the life quality of female patients. KEYWORDS: genital prolapse, combined laparoscopic surgery, mesh implants, surgical treatment of pelvic organ prolapse, laparoscopic sacrocolpopexy, laparoscopic pectopexy, life quality. FOR CITATION: Pyatkina A.N., Bryunin D.V., Chushkov Yu.V. Laparoscopic correction methods of pelvic organ prolapse. Russian Journal of Woman and Child Health. 2024;7(1):18–25 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-3.

Laparoscopic pectopexy: As a safe and effective new approach for repair of pelvic organ prolapse

Abstract Objective: The objective is to assess the feasibility, safety, and effectiveness of laparoscopic pectopexy for repair of pelvic organ prolapse (POP). Design: This was a prospective study. Materials and Methods: A total of 324 women of POP-Q Stage ≥II who underwent laparoscopic pectopexy between January 2017 and January 2023 at Jaipur Doorbeen Hospital, Jaipur, India were included in this study. All patients underwent laparoscopic mesh fixation to bilateral pectineal ligament with Moschcowitz repair with pelvic floor repair. Results: Among 324 patients, the mean age was 48.29 ± 14.82 years and the mean body mass index was 24.10 ± 3.19 kg/m2 . Out of 324 cases, 24.07% of Stage II, 71.30% of Stage III, and 4.63% of Stage IV. Maximum cases were under Stage III (71.30%). Follow up was done after 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year. At 1 year of follow up out of 324 cases, 66 patients lost to follow up. Out of the remaining 258 patients, only 9 (3.4%) patients show recurrence of prolapse. Out of nine cases, four cases show Stage I cystocele, three cases show Stage II apical prolapse and two cases show Stage 1 rectocele. Results are promising, with 96.51% all over success rate. Conclusion: The laparoscopic pectopexy is a good alternative to the laparoscopic sacrocolpopexy. It is equally effective and shows no de novo stress urinary incontinence, defecation disorders, backache, or neuralgia in the long term follow up.

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.

Comparison of Different Laparoscopic Sacrocolpopexy Procedures: A Retrospective Dual Center Analysis.

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques.

Iliac vein variation in the sacral promontory on three-dimensional computed tomography angiography: a prospective observational study before laparoscopic sacrocolpopexy

Introduction and HypothesisVenous injury may occur during exposure of the anterior longitudinal ligament at the anterior sacral promontory (SP). We aimed to quantitatively measure the extent of the vascular window (VW) in front of the SP in patients with internal iliac vein (IIV) variations using preoperative three-dimensional computed tomography angiography (3DCTA). We hypothesized that patients with IIV variations would have a narrow VW.MethodsThis prospective observational study included patients scheduled for laparoscopic sacrocolpopexy (LSC) between July 2022 and April 2023 who underwent preoperative 3DCTA. The primary endpoint was the VW measurement in the standard and variant IIV groups using 3DCTA before LSC. The secondary endpoint was the difference between the two IIV groups adjusted for age, body mass index, hypertension, and diabetes using an analysis of covariance (ANCOVA) model. Multiple regression analysis was performed to analyze the effect of factors on the distance from the SP to great vascular bifurcations.ResultsThere were 20 cases of IIV variation (20.2%). VW was 28.8 ± 12.4 mm in the variant group and 39.6 ± 12.6 mm in the standard group (p = 0.001). In the ANCOVA model, IIV variations affected VW (coefficient, –11.8; 95% confidence interval [CI], –18.4 to –5.08, p < 0.001). Multivariate analysis revealed that the aorta–SP distance decreased with age (coefficient, −0.44; 95% CI, −0.77 to −0.11, p = 0.009).ConclusionsOne in five women has a vascular variant at the SP that restricts the “safe” zone of fixation to < 3 cm.

Laparoscopic sacrocolpopexy for treatment of pelvic organ prolapse, a prospective observation cohort with follow-up time over 7 years.

Laparoscopic sacrocolpopexy for treatment of pelvic organ prolapse, a prospective observation cohort with follow-up time over 7 years.

Effect of age in women undergoing laparoscopic sacrocolpopexy: A retrospective study.

To determine whether elderly women (≥65 years) have an increased risk of complications and lower success when undergoing laparoscopic sacrocolpopexy (LSC) compared with younger women (<65 years). This was a retrospective study of all LSC procedures performed from August 2014 to February 2021 by a single urogynecologic surgeon in an academic affiliated hospital system. Charts were identified through procedure codes. Patient demographics, clinical, surgical, and postoperative data were collected. The primary outcome of this study was to compare complications associated with LSC, including intraoperative and postoperative complications. Secondary outcomes included subjective, objective, and composite success. In total, 312 participants met the criteria. The mean age of the group who were younger than 65 years was 55.7 years (±6.5) and of the group aged 65 years or older was 69.3 years (±3.5). Racial demographics revealed no differences between the two groups. Patients aged 65 years or older had a statistically significant lower body mass index (calculated as weight in kilograms divided by the square of height in meters), a higher rate of hypertension, smaller genital hiatus, and a larger anterior vaginal wall prolapse compared with the younger cohort. They also less often underwent a posterior repair. No statistically significant differences were found with regards to intraoperative and postoperative complications, including 30-day re-admission, between the two age groups. Both groups had high anatomic success rates, with no significant difference (<65 = 96.3%; ≥65 = 98.4%; P = 0.326). Those aged younger than 65 years compared with those aged 65 years or older had lower subjective success that was not significantly different (<65 = 62.8%; ≥65 = 71.0; P = 0.134). Composite success was noted to reach the threshold of a statistically significant difference in the group aged younger than 65 years compared with those aged 65 years or older (60.1% vs 71.0%; P = 0.0499). In this study, elderly patients did not have increased intraoperative and postoperative complications after undergoing LSC. Similar rates of anatomic and subjective success were also found with younger patients having a lower composite success. Proper candidates for LSC should not be excluded based upon age.

Efficacy of laparoscopic pectopexy versus laparoscopic sacrocolpopexy and antibacterial performance of nanosilver-coated urethral catheter for postoperative catheterization in patients with pelvic organ prolapse

This study aimed to compare the clinical efficacy of laparoscopic sacrocolpopexy (LSC) and laparoscopic pectopexy (LP) for the treatment of pelvic organ prolapse (POP) and to evaluate the antibacterial effect of nanosilver-coated urethral catheters. The clinical data of 112 patients with POP, including 56 patients who underwent LP and 56 patients who underwent LSC, from March 1, 2019 to March 31, 2021 were retrospectively evaluated. All patients underwent routine catheterization with nanosilver-coated urethral catheters after surgery. The baseline data, intraoperative and postoperative efficacy, serum inflammatory indexes and postoperative complications were compared. The surgery was successfully completed in both groups, and a total of 10 patients in both group underwent intraoperative repair of the anterior and posterior vaginal walls. The surgical duration was significantly shorter and the intraoperative blood loss was significantly lower in the LP group than in the LSC group (P &lt;0.05 for both). In both groups, the POP quantification stage, which was ≥I prior to surgery, was ≤I at six months after surgery. The PFIQ-7, PFDI-20 and PISQ-12 scores were significantly improved in both groups (P &lt;0.05 for all), and the improvements were significantly better in the LP group than in the LSC group (P &lt;0.01). During the 6-month follow-up period, no patient developed urinary tract infection. The levels of postoperative serum inflammatory factors WBC, ESR and CRP were increased in the LSC group and higher than those in the LP group, highlighting the significant anti-infection effect of the nanosilver-coated catheter. Mesh exposure occurred in one patient in the LSC group. In the LSC group, postoperative symptoms including abnormal defecation, lower abdominal pain/soreness, new stress urinary incontinence, and dyspareunia. In the LP group, abnormal defecation and lower abdominal pain were present in one patient each. The rate of postoperative complications was higher in the LSC group than in the LP group. While both LSC and LP could restore pelvic floor anatomic structure and organ function in patients with POP, shorter surgical duration, less blood loss, and better therapeutic effect were observed in patients undergoing LP. Nanosilver-coated antibacterial catheters exhibited good antibacterial effect in patients with routine catheterization after surgery. This study provides a new treatment plan for the treatment of pelvic organ prolapse, and also provides a new nursing method for postoperative urinary tract infection.