Laparoscopic Sacrohysteropexy Research Articles

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.

The Manchester procedure combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling

This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time, and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix.

Laparoscopic sacrohysteropexy versus vaginal sacrospinous hysteropexy as treatment for uterine descent: comparison of long-term outcomes

Introduction and hypothesisPelvic organ prolapse (POP) is a frequent occurring health issue, especially concerning elderly women. The objective of this study is to examine the long-term outcomes of laparoscopic sacrohysteropexy (LSH) and vaginal sacrospinous hysteropexy (SSHP) for treatment of uterine prolapse.MethodsA retrospective study of patients who underwent a LSH or SSHP. Validated questionnaires and an outpatient examination visit were used to investigate the effects of both surgical treatments. The primary outcome was the composite outcome of success for the apical compartment, defined as no recurrence of uterine prolapse (POP-Q measurement C ≤ 0), no subjective recurrence of POP, and/or not requiring therapy for recurrent prolapse. Secondary outcomes were peri- and postoperative data, anatomical failure, prolapse beyond hymen, subjective outcomes, and disease-specific quality of life.ResultsWe included 105 patients, 53 in the LSH group and 52 in the SSHP group. The overall response rate of the questionnaires was 83% (n = 87) after a mean follow-up time of 4.5 years (54.2 months; 95% CI 44.8–64.2 months) in the LSH group and 2.5 years (30.1 months; 95% CI 29.3–31.5 months) in the SSHP group. There were no clinically relevant differences between the study groups in composite outcome of success (p = 0.073), anatomical failure of the apical compartment (p = 0.711), vaginal bulge symptoms for which patients consulted professionals (p = 0.126), and patient satisfaction (p = 0.741). The operative time was longer in the LSH group (117 min; interquartile range (IQR) 110–123) compared to the SSHP group (67 minutes; IQR 60–73) (p < 0.001). The duration of hospital stay was also longer in the LSH group (4 days) than in the SSHP group (3 days) (p = 0.006).ConclusionsLSH and SSHP seem to be equally effective after long-term follow-up in treating uterine prolapse in terms of objective and subjective recurrence.

Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension.

Long-term durability and functional outcome of laparoscopic sacrohysteropexy (LSH) remains to be confirmed. We set out to assess the development of surgical outcome in women with increasing minimal follow-up. All women after LSH with anterior and posterior mesh extension operated for advanced apical uterine prolapse at Geoffroy Saint-Hilaire clinic from July 2005 to June 2020 were enrolled in this retrospective study. Last known follow-up information was used for the analysis and allocation into groups. The surgical success was defined as no prolapse beyond hymen, no symptomatic recurrence or no retreatment. Functional outcome was evaluated from validated questionnaires and presence of pelvic floor disorders. The outcomes were compared with preoperative state using chi-square and Fisher's test; p < 0.05 was considered significant. In total, 270 patients after LSH with a follow-up of up to 14.5years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5years 76, ≥ 7years 45 and ≥ 10 years 18 women. Increase of minimal follow-up was associated with gradual decrease in surgical success. Rates of stress urinary incontinence were unchanged by the surgery, while anal incontinence and constipation rates decreased significantly; 14.5% of women were operated on for SUI in the follow-up. The PFDI-20, PFIQ-7 and VAS bother scores decreased significantly regardless of minimal follow-up length. LSH with anterior and posterior mesh extension is a safe, effective and durable surgery with a positive long-term effect on quality of life. Although the surgical success gradually decreases, LSH remains a surgical success in most women.

Effect of Age on Complications Rate and Surgical Outcomes in Women Undergoing Laparoscopic Sacrohysteropexy and Sacrocolpopexy

Study ObjectiveTo compare perioperative and long-term outcomes of laparoscopic sacrohysteropexy/sacrocolpopexy in different groups of age. DesignThis was a retrospective cohort study. Patients were evaluated preoperatively and postoperatively (starting from 1 month after surgery and then annually). SettingThe department of functional pelvic surgery and oncology, a tertiary care center. PatientsAll patients who underwent laparoscopic sacrohysteropexy/sacrocolpopexy, between July 2005 and December 2019. InterventionsLaparoscopic sacrohysteropexy/sacrocolpopexy. Measurements and Main ResultsThe study population was divided into 3 groups, according to age at the time of surgery: group 1, <65 years; group 2, between 65 and 75 years, and group 3, >75 years. The primary outcome was the rate of perioperative complications. The secondary outcome was the comparison of long-term results among the groups. A total of 330 patients were included: in group 1, 183 patients (mean age 53.4 ± 8.2), in group 2, 92 patients (mean age 69.2 ± 2.9), and in group 3, 55 patients (mean age 79.3 ± 3.5). The overall perioperative complications rate (up to 30 days after surgery) was 5.7%. No differences among the groups in operative details and rates of perioperative complications were observed. During the follow-up period, 37 patients (11.2%) presented with prolapse recurrence (objective and/or subjective); the rates of prolapse recurrence and long-term complications were similar among the groups. Similarly, the groups did not differ in postoperative functional results except for postoperative stress urinary incontinence. A surgery for stress urinary incontinence was more common among patients in group 3 (group 1, 13.4%; group 2, 11.9%; group 3, 31.3%; p = .008). ConclusionLaparoscopic sacrohysteropexy/sacrocolpopexy is associated with low rates of perioperative and long-term complications. We did not find a difference in rates of complications and/or long-term outcomes, between different age groups.

Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial

Introduction and hypothesisLaparoscopic mesh sacrohysteropexy offers a uterine-sparing alternative to vaginal hysterectomy with apical suspension, although randomised comparative data are lacking. This study was aimed at comparing the long-term efficacy of laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse.MethodsA randomised controlled trial comparing laparoscopic mesh sacrohysteropexy and vaginal hysterectomy with apical suspension for the treatment of uterine prolapse was performed, with a minimum follow-up of 7 years. The primary outcome was reoperation for apical prolapse. Secondary outcomes included patient-reported mesh complications, Pelvic Organ Prolapse Quantification, Patient Global Impression of Improvement in prolapse symptoms and the International Consultation on Incontinence Questionnaire Vaginal Symptoms, Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and PISQ-12 questionnaires.ResultsA total of 101 women were randomised and 62 women attended for follow-up at a mean of 100 months postoperatively (range 84–119 months). None reported a mesh-associated complication. The risk of reoperation for apical prolapse was 17.2% following vaginal hysterectomy (VH) and 6.1% following laparoscopic mesh sacrohysteropexy (LSH; relative risk 0.34, 95% CI 0.07–1.68, p = 0.17). Laparoscopic sacrohysteropexy was associated with a statistically significantly higher apical suspension (POP-Q point C −5 vs −4.25, p = 0.02) and longer total vaginal length (9 cm vs 6 cm, p < 0.001). There was no difference in the change in ICIQ-VS scores between the two groups (ICIQ-VS change −22 vs −25, p = 0.59).ConclusionLaparoscopic sacrohysteropexy and vaginal hysterectomy with apical suspension have comparable reoperation rates and subjective outcomes. Potential advantages of laparoscopic sacrohysteropexy include a lower risk of apical reoperation, greater apical support and increased total vaginal length.

Long term outcomes of laparoscopic sacro/colpo-hysteropexy with and without rectopexy for the treatment of prolapse.

Laparoscopic sacrohysteropexy (LSH), sacrocolpopexy (LSC) and ventral rectopexy (LVR) with mesh are advocated for surgical treatment of pelvic and rectal prolapse. Our study aims at showing the feasibility of concomitant laparoscopic prolapse repair by comparing perioperative and long-term outcomes of LSH or LSC with and without LVR. This is a retrospective study carried out on 348 women operated on between July 2009 and July 2019. Patients were divided into four groups: (1) LSH only, (2) LSC only, (3) LSH + LVR and (4) LSC + LVR. POP-Q scores and satisfaction questionnaires were recorded at baseline and then annually. Outcomes were defined as subjective failure (vaginal/rectal prolapse symptoms), objective failure (prolapse to/beyond the hymen, full thickness rectal prolapse) or retreatment for prolapse. Complications were collected and graded according to the Clavien-Dindo classification. Three hundred forty-eight women underwent laparoscopic repair for pelvic and rectal prolapse (219, 44, 66 and 19 in group 1, 2, 3 and 4, respectively). Median follow-up was 24 (4-174)months. Success rate for both rectal and pelvic prolapse was 90.2%. Recurrence rates were not significantly different between the groups (12.3%, 6.8%, 9.1% and 10.5% for groups 1, 2, 3 and 4, respectively). Significant improvement was noticed in satisfaction questionnaires in all groups. There was no difference in perioperative and late complications. The combined laparoscopic procedure appears to be safe and efficient in treating pelvic and rectal prolapse. Appropriate patient selection and available surgical expertise should determine whether to perform these procedures combined or separately.

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.

Comparison of the Quality of Life and Female Sexual Function Following Laparoscopic Pectopexy and Laparoscopic Sacrohysteropexy in Apical Prolapse Patients.

Objectives:We sought to compare the surgical outcomes, safety, effectiveness, and mid-term outcomes in patients who had undergone laparoscopic hysterosacropexy and laparoscopic pectopexy due to apical prolapse.Materials and Methods:This prospective randomized study was conducted on a total of 62 women who underwent apical prolapse surgery (32 undergoing a pectopexy and 30 undergoing a sacrohysteropexy) between June 2015 and June 2017. Patients with symptomatic uterine or vaginal vault prolapse with stage 2 or worse were included in the sudy. Before and after the operation, we used the Pelvic Organ Prolapse Quantification System (POP-Q) and questionnaires, which are the Prolapse Quality of Life Questionnaire (P-QOL) and Female Sexual Function Index (FSFI), to evaluated cases. Baseline characteristics, perioperative and postoperative complications, and follow-up results at 12 months were also evaluated.Results:All domains of POP-Q, P-QOL, and FSFI scores improved significantly after surgery both in pectopexy and sacrohysteropexy group. The postoperative complications of both procedures were similar except for constipation after surgery (3.2% in the pectopexy group and 20% in the hysterosacropexy group [P = 0.036]).Conclusion:Both sacrohysteropexy and pectopexy are effective surgical options for apical prolapse patients. The pectopexy is an acceptable alternative to laparoscopic sacrohysteropexy because of its less complexity and not reducing pelvic space for the rectum to exist. We suggest that the laparoscopic pectopexy may be widely used in clinical routine.

Vaginal-assisted Laparoscopic Sacrohysteropexy and Vaginal Hysterectomy with Vaginal Vault Suspension for Advanced Uterine Prolapse: 12-month Preliminary Results of a Randomized Controlled Study.

Objective:Vaginal-assisted laparoscopic sacrohysteropexy (VALH) is a new modified form of uterine-sparing prolapse surgery using a combined vaginal and laparoscopic approach. We aimed to compare 1 year efficacy and safety of VALH and vaginal hysterectomy with vaginal vault suspension (VH + VVS) in the surgical treatment of apical pelvic organ prolapse (POP).Materials and Methods:Women who requested surgical treatment for stage 2–4 symptomatic uterine prolapse were recommended to participate in one year-long randomized study between July 2017 and January 2019. POP Quantification (POP-Q) examination and validated questionnaires such as International Consultation on Incontinence Questionnaire Vaginal Symptoms (IVIQ-VS) survey, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire Short Form (IIQ-7), and Patient Global Impression of Improvement (PGI-I) were recorded at baseline and 12 months after surgery. The main primary outcome measure was apical prolapse recurrence. Secondary results were duration of surgery, pain score, blood loss, postoperative hospital stay, and quality of life scores related to prolapse.Results:There were 15 women in VALH and 19 women in the VH + VVS group. ICIQ-VS score, ICIQ-QOL, UDI-6, and IIQ-7 scores were improved for both groups. According to the PGI-I scores, 80% of subjects in the VALH group, and 100% in the VH + VVS group, were “very much better” or “much better” with their prolapse symptoms at their 1-year follow-up. There was no reoperation or operation-related complication in both groups.Conclusion:VALH and VH + VVS have similar 1-year cure rates and patient satisfaction.

Success Rates and Outcomes of Laparoscopic Mesh Sacrohysteropexy

Study Objective This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Design Retrospective cohort study. Setting Private Practice. Patients or Participants 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Interventions Laparoscopic mesh sacrohysteropexy. Measurements and Main Results The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Conclusion Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse. This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Retrospective cohort study. Private Practice. 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Laparoscopic mesh sacrohysteropexy. The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse.

Laparoscopic minimally invasive sacrocolpopexy or hysteropexy and transobturator tape combined with native tissue repair of the vaginal compartments in patients with advanced pelvic organ prolapse and incontinence.

The aim of the study was to evaluate hysterectomized and non-hysterectomized patients with prolapse and incontinence. Laparoscopic sacrohysteropexy (LSHP) and minimally invasive sacrocolpopexy (LMSCP) were done in combination with transobturator tape (TOT) and native tissue repair of the anterior and posterior vaginal compartments in patients with pelvic organ prolapse (POP) and occult, stress, or urinary incontinence (SUI). The hypothesis is that both methods are successful. A total of 81 patients with POP were evaluated: 44 had vaginal vault prolapse (POPQ points Ba, C, and Bp were 1.2, 2.6, and 0.4, respectively) and 37 had uterine prolapse (POPQ points Ba, C, and Bp were 1.8, 1.7, and 1.3, respectively). LMSCP (which means less dissection of the vagina in its upper third and avoiding possible collision with the ureters anteriorly or the rectum posteriorly) was performed in patients with vault prolapse, whereas patients with uterine prolapse underwent LSHP. Transobturator tape (TOT) was placed in all patients to treat symptomatic and occult urinary incontinence. Systematic anterior and posterior colporrhaphy was performed in both groups. Both groups showed anatomic (p < 0.0001) and symptomatic improvement (p < 0.001-p < 0.05). Voiding was significantly improved after surgery without postoperative incontinence (p < 0.001). There was no significant difference between groups regarding duration of surgery (p = 0.06), hospital stay (p = 0.13), blood loss (0.83), Clavien-Dindo grade 3 (p = 0.87), and Clavien-Dindo grade 1-2 (p = 0.92) complications. Minimally invasive LSCP or LSHP combined with TOT and native tissue repair of the anterior and posterior vaginal compartment is a successful treatment for POP.

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy-a multicentre randomised controlled trial (LAVA trial).

To investigate whether laparoscopic sacrohysteropexy (LSH) is non-inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse. Multicentre randomised controlled, non-blinded non-inferiority trial. Five non-university teaching hospitals in the Netherlands, one university hospital in Belgium. 126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery. Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%. Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP-Q≥2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life. Laparoscopic sacrohysteropexy was non-inferior for surgical failure (n=1, 1.6%) compared with SSHP (n=2, 3.3%, difference -1.7%, 95% CI: -7.1 to 3.7) 12months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP. Laparoscopic sacrohysteropexy was non-inferior to SSHP for surgical failure of the apical compartment at 12months' follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent. Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short-term outcomes.

Dynamic magnetic resonance imaging to quantify pelvic organ mobility after treatment for uterine descent: differences between surgical procedures.

Pelvic organ mobility is defined as the displacement of pelvic organs between rest and maximal straining. We hypothesized that pelvic organ mobility after vaginal sacrospinous hysteropexy (SSHP) might be increased compared with other surgeries for uterine descent, which may contribute to the high occurrence of postoperative cystocele after this surgery. Pelvic organ mobility and the vaginal axes after SSHP are compared with other surgical procedures for uterine descent: vaginal hysterectomy with uterosacral suspension (VH) and laparoscopic sacrohysteropexy (LSH). In this prospective pilot study, 15 women were included (5 for each procedure). Six months postoperatively, POP-Q examination and dynamic MRI were performed and questionnaires were filled out regarding prolapse complaints. Pelvic organ mobility on MRI was defined as vertical displacement of pelvic organs at rest and maximal straining. The displacements and angles were measured using an image registration method. Furthermore, the angle of displacement of cervix/vaginal vault and vaginal axes were assessed. No anatomical recurrences of pelvic organ prolapse were found. No difference in pelvic organ mobility was demonstrated. After VH, a more posterior position of the upper vagina was found compared with SSHP and LSH. Based on these data, the higher recurrence risk in the anterior compartment after SSHP cannot be explained. Larger sample sizes, studying women with recurrence or de novo cystocele after SSHP or using an upright MRI scanner would be of interest to further assess the relationship between pelvic organ mobility and the occurrence of anterior vaginal wall prolapse.

A Meshless Practical Laparoscopic Sacrohysteropexy Modification and Long-term Outcomes

Study ObjectiveTo describe a new modification of laparoscopic sacrohysteropexy without using a mesh and report the 3-year outcomes. DesignA prospective cohort study. SettingMinimally Invasive Gynecology Unit, Bursa Uludag University Hospital, Turkey. PatientsWomen who were diagnosed with ≥ stage 2 uterine prolapse. InterventionsA laparoscopic sacrohysteropexy modification using a polyester fiber suture instead of a standard polypropylene mesh. Measurements and Main ResultsThe primary outcome was the anatomic success of the repair, with success defined as objective parameters using the pelvic organ prolapse quantification system. The secondary outcomes were subjective outcomes, which were assessed using the quality-of-life scales. Forty-seven women who underwent the procedure were followed up for a minimum of 3 years. Forty-four of the 47 patients had stage 0 or 1 prolapse at the end of the second year, according to the primary outcomes. The anatomic success rate was 93.6%. In the secondary outcomes, 2 patients were not satisfied with their pelvic floor after the second year. The subjective cure rate was 95.7%. There was a statistically significant improvement in both pelvic organ prolapse quantification and quality-of-life scores in the third postoperative year. The mean operating time was 84.6 minutes, and the mean estimated blood loss was 21.3 mL. There were no bladder or bowel complications in the perioperative or postoperative period. ConclusionLaparoscopic sacrohysteropexy can be performed safely with this meshless modification in uterine prolapse as an alternative.

Comparison of patient reported outcomes, pelvic floor function and recurrence after laparoscopic sacrohysteropexy versus vaginal hysterectomy with McCall suspension for advanced uterine prolapse

ObjectiveTo compare medium/long-term outcomes in terms of pelvic floor function, patient reported prolapse recurrence and repeat prolapse surgery after laparoscopic sacrohysteropexy (LSHP) and vaginal hysterectomy with McCall suspension (VH&McCall) which is the most commonly performed surgical option for severe uterine prolapse from past to present. Study DesignFiles of patients who underwent LSHP and VH&McCall for advanced utero-vaginal prolapse (stage 3 & 4) at the Department of Gynecology in Ankara University School of Medicine between 2008 and 2018 were reviewed (n = 517). Data of women who were followed up for at least 1-year and containing both the full-filled Patient Global Impression of Improvement (PGI-I) survey and Turkish validated Pelvic Floor Distress Inventory-20 (PFDI-20), were included. ResultsA total of 132 women were included in the study; 46 women who underwent LSHP and 86 women who underwent VH&McCall. Even though the median age of the LSHP group was significantly lower than the median age of VH&McCall group (42 vs. 67 years; P<;0.001), recurrence and repeat surgery rates were found to be similar after both surgical approaches as well as the scores of PGI-I and PFDI-20. However, in women who were operated before their sixties, symptomatic recurrence was found to be significantly lower after LSHP than VH&McCall (16.2 % vs. 47.4 %, respectively; P = 0.024) as well as repeat prolapse surgery (2.7 % vs. 26.3 %, respectively; P = 0.014). PGI-I and PFDI-20 scores also suggested better pelvic floor function after LSHP significantly (p = 0.004 & p = 0.003 respectively). When adjusted for age, VH&McCall significantly increased the risk of symptomatic prolapse recurrence compared to LSHP (OR: 4.65; 95 % CI: 1.326–16.312; P = 0.016). ConclusionLSHP and VH&McCall might seem to be surgical options for individualized management with similar pelvic floor function & recurrence in the medium/long-term follow-up, but the age adjusted risk analysis showed higher rates of symptomatic recurrence after VH&McCall. Moreover, the better outcomes after LSHP in the younger subset, revealed the need of further clarification with well-designed prospective studies.

Sacrohysteropexy: A Way to Spare the Uterus

To show the safety and feasibility of laparoscopic sacrohysteropexy for treating uterine prolapse. An educational video to explain the laparoscopic steps of this procedure by focusing on the main anatomic landmarks and on tips and tricks to avoid complications. A tertiary care university hospital. Laparoscopic sacropexy with uterus preservation for grade 3 apical defect. This video shows a stepwise approach to laparoscopic sacrohysteropexy demonstrating its feasibility and safety. There is a wide choice of surgical procedures and approaches focused on pelvic organ prolapse repair. Since many years, uterine prolapse has been an indication for hysterectomy, regardless of the occurrence of uterine disease and patients' desires. With the introduction of minimally invasive surgery, the uterine-sparing procedures are being increasingly taken into account, especially in young women [1]. Sacrohysteropexy is a uterus-sparing procedure that allows for a reduction in operating time, intraoperative blood loss, mesh-related complications, and surgical costs [2]. Furthermore, this technique has a high success rate with an objective cure rate of 100% for the apical compartment and 80% for all compartments and does not seem to increase the pelvic organ prolapse recurrence rate [3]. Sacropexy is not a life-threatening procedure, but its main objective is to restore functional anatomy with the primary goal of improvement in patient's quality of life. Moreove, no difference has been found with or without uterus preservation in term of postoperative recurrence rate or ent's quality of life [4]. However, high patient satisfaction has been recently reported; therefore, uterine preservation should be considered during patient's counseling.

Total Laparoscopic Cerclage Sacrohysteropexy

Video Objective There has been a growing interest among both patients and surgeons in preserving the uterus during the treatment of pelvic organ prolapse. In this video we are demonstrating a novel surgical approach towards the treatment of pelvic organ prolapse. This surgical procedure simplifies the laparoscopic sacrohysteropexy procedure by significantly reducing endoscopic suturing and knot tying, without the need for a combined laparoscopic and vaginal surgical approach. Setting A 69 -year-old G2P2 Caucasian female suffering from stage II pelvic organ prolapse. Her POP-Q was notable for anterior and apical prolapse to the level of the hymen. The laparoscopic cerclage sacrohysteropexy was initiated following a bilateral salpingo-oophorectomy and completed entirely from the laparoscopic approach. Interventions Laparoscopic cerclage sacrohysteropexy. Conclusion This case demonstrates that a laparoscopic cerclage sacrohysteropexy is an efficient, simple, and time saving surgical option for women with pelvic organ prolapse.

Laparoscopic Mesh Sacrohysteropexy: A Uterine Conserving Technique for Uterovaginal Prolapse

Video Objective The purpose of the video is to describe the surgical technique involved in performing laparoscopic mesh sacrohysteropexy. A brief review of the outcomes from a 10 year retrospective single centre cohort study will be discussed. Setting Laparoscopic mesh sacrohysteropexy is a uterine conserving surgical technique for the management of apical vaginal prolapse. Interventions Laparoscopic mesh sacrohysteropexy involves fixing non-absorbable mesh from the posterior cervix to the sacral promontory. This is then covered with peritoneum from the para-rectal space. Conclusion A ten year retrospective cohort study has demonstrated success in 86% of patients with no further vaginal surgery required during the follow up period. This technique is useful for women wishing uterine preservation or for women who would be unable to tolerate a longer procedure such as a laparoscopic hysterectomy and sacrocolpopexy.

Sacrohysteropexy with Anterior and Posterior Attachment

Video Objective This video discusses patient selection, different surgical approaches, and outcomes data for sacrohysteropexy. We present a case presentation employing one of the approaches to sacrohysteropexy. Setting This video presents a case of a 40 year old female with Stage II uterovaginal prolapse who seeks a durable surgical repair. She does not desire future fertility and has risk factors for native tissue repair failure. Interventions The patient underwent a robotic-assisted laparoscopic sacrohysteropexy, bilateral salpingectomy, and posterior colporrhaphy. Conclusion Sacrohysteropexy is an effective and appropriate surgery for patients with uterovaginal prolapse and risk factors for native tissue failure who do not want a hysterectomy. Sacrohysteropexy can be performed with a posterior vaginal attachment only or with posterior and anterior vaginal attachments. The posterior only attachment is best for patients who may desire future fertility as it does not involve surgery into the broad ligament or anterior cul-de-sac. There are two approaches to sacrohysteropexy that also include an anterior attachment to provide anterior vaginal support. Both approaches bring anterolateral mesh arms through windows created in the broad ligament. One technique sutures these arms in addition to the posterior mesh's sacral arm to the sacral promontory. The other technique sutures the lateral arms to the posterior cervix leaving only the posterior mesh sacral arm to be attached at the sacral promontory. Overall sacrohysteropexy has been shown to have a symptomatic success rate of 90-95% and an anatomical success rate of 70%. Sacrohysteropexy has been shown to have reduced operative time, blood loss, hospital stay length, and to have greater vaginal length preservation than its hysterectomy with sacrocolpopexy alternative.