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Updates in Minimally Invasive Approaches to Apical Pelvic Organ Prolapse Repair

  • Jeffrey S. Schachar
  • Catherine A. MatthewsEmail author
Urogynecology (P Nikpoor, Section Editor)
  • 13 Downloads
Part of the following topical collections:
  1. Topical Collection on Urogynecology

Abstract

Purpose of Review

The purpose of this article is to review and comment on the recent medical evidence regarding minimally invasive procedures for apical pelvic organ prolapse repair.

Recent Findings

Sacrocolpopexy remains the “gold standard” repair for apical prolapse for those who desire to maintain sexual function, and minimally invasive approaches offer equal efficacy with lower risk than open sacrocolpopexy. Similar to the impact on hysterectomy rates, the introduction of robotic technology has converted a large number of open abdominal sacrocolpopexy procedures to a minimally invasive approach in the USA. Newer surgical approaches such as nerve-sparing techniques of dissection at the sacral promontory, use of the iliopectineal ligaments, and natural orifice vaginal sacrocolpopexy offer potential improvements for apical repair. Whether using traditional laparoscopy or robotic assistance, prolapse recurrence is consistently noted in at least 10% of patients. Recent evidence has confirmed that ancillary factors including pre-operative prolapse stage, retention of the cervix and/or uterus, type of mesh implant, and genital hiatus size all adversely affect surgical efficacy. Minimally invasive apical repair procedures seem well suited to early recovery after surgery protocols. While overall complication rates are low, small bowel injury is higher with any abdominal approach and aggressive evaluation of women not meeting routine post-operative goals is advised.

Summary

Minimally invasive sacrocolpopexy has achieved similar outcomes to the traditional abdominal route and should be considered the new “gold standard” in apical prolapse repair. Alterations in surgical techniques can reduce the risk of constipation.

Keywords

Apical prolapse Minimally invasive Update Sacrocolpopexy Pelvic organ prolapse 

Notes

Compliance with Ethical Standards

Conflict of Interest

Jeffrey S. Schachar and Catherine A. Matthews declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology and Obstetrics and GynecologyWake Forest Baptist HealthWinston-SalemUSA

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