Skip to main content
SpringerLink
Log in

The challenge of implementing laparoscopic sacrocolpopexy

  • Clinical Opinion
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Vaginal-vault prolapse is effectively treated using sacrocolpopexy (SCP). A randomized trial demonstrated that it can be performed as effectively via laparoscopy (LSCP) as via laparotomy and with less morbidity. This evidence begs the question of how units offering abdominal sacrocolpopexy will implement LSCP. Several limitations need to be overcome. LSCP initially requires longer operating time; however, that decreases with surgeon experience. To decrease operation time, suture training can be implemented ahead. Following a 15-h suturing lab, trainees achieved comparable operation times after 30 cases. Dissection is another critical time-consuming step and is difficult to model. Proficiency is more dependent on patient characteristics, though this component is poorly studied. One experience showed it takes 60 procedures to effectively limit complications. The large number of patients required for surgeon training for this relative infrequent operation creates a problem, thus limiting the number of centers available for training surgeons within a reasonable period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, Zyczynski H, Pelvic Floor Disorders N (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104(4):805–823. doi:10.1097/01.AOG.0000139514.90897.07

    Article  PubMed  Google Scholar 

  2. Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014. doi:10.1002/14651858.CD004014.pub5

    PubMed  Google Scholar 

  3. Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, Vallancien G (2009) The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 55(5):1089–1103. doi:10.1016/j.eururo.2009.01.048

    Article  PubMed  Google Scholar 

  4. Jacquetin B, Fatton B, Rosenthal C, Clave H, Debodinance P, Hinoul P, Gauld J, Garbin O, Berrocal J, Villet R, Salet Lizee D, Cosson M (2010) Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J Pelvic Floor Dysfunct 21(12):1455–1462. doi:10.1007/s00192-010-1223-0

    Article  Google Scholar 

  5. Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O’Rourke P (2011) Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 204(4):360 e361–367. doi:10.1016/j.ajog.2010.11.016

    Article  Google Scholar 

  6. Maher CF, Connelly LB (2012) Cost minimization analysis of laparoscopic sacral colpopexy and total vaginal mesh. Am J Obstet Gynecol 206(5):433 e431–437

    Article  Google Scholar 

  7. Iglesia CB, Hale DS, Lucente VR (2013) Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse. Int Urogynecol J 24(3):363–370. doi:10.1007/s00192-012-1918-5

    Article  PubMed  Google Scholar 

  8. Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, Slack M, Scott P, Waterfield M (2012) A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. doi:10.1007/s00192-012-1885-x

    Google Scholar 

  9. Patel M, O’Sullivan D, Tulikangas PK (2009) A comparison of costs for abdominal, laparoscopic, and robot-assisted sacral colpopexy. Int Urogynecol J Pelvic Floor Dysfunct 20(2):223–228. doi:10.1007/s00192-008-0744-2

    Article  PubMed  Google Scholar 

  10. Judd JP, Siddiqui NY, Barnett JC, Visco AG, Havrilesky LJ, Wu JM (2010) Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol 17(4):493–499. doi:10.1016/j.jmig.2010.03.011

    Article  PubMed  Google Scholar 

  11. Dallenbach P, Kaelin-Gambirasio I, Jacob S, Dubuisson JB, Boulvain M (2008) Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1623–1629. doi:10.1007/s00192-008-0718-4

    Article  PubMed  Google Scholar 

  12. Subramanian D, Szwarcensztein K, Mauskopf JA, Slack MC (2009) Rate, type, and cost of pelvic organ prolapse surgery in Germany, France, and England. Eur J Obstet Gynecol Reprod Biol 144(2):177–181. doi:10.1016/j.ejogrb.2009.03.004

    Article  PubMed  Google Scholar 

  13. Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, Coremans G, Deprest J (2009) Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 55(6):1459–1467. doi:10.1016/j.eururo.2008.12.008

    Article  PubMed  Google Scholar 

  14. Claerhout F, Roovers JP, Lewi P, Verguts J, De Ridder D, Deprest J (2009) Implementation of laparoscopic sacrocolpopexy–a single centre’s experience. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1119–1125. doi:10.1007/s00192-009-0914-x

    Article  PubMed  Google Scholar 

  15. Claerhout F et al (2014) Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps. Int Urogynaecol J. doi:10.1007/s00192-014-2412-z

  16. Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC (2007) Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol 21(8):926–930. doi:10.1089/end.2006.0381

    Article  PubMed  Google Scholar 

  17. Akladios CY, Dautun D, Saussine C, Baldauf JJ, Mathelin C, Wattiez A (2010) Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obstet Gynecol Reprod Biol 149(2):218–221. doi:10.1016/j.ejogrb.2009.12.012

    Article  PubMed  Google Scholar 

  18. Mustafa S, Amit A, Filmar S, Deutsch M, Netzer I, Itskovitz-Eldor J, Lowenstein L (2012) Implementation of laparoscopic sacrocolpopexy: establishment of a learning curve and short-term outcomes. Arch Gynecol Obstet 286(4):983–988. doi:10.1007/s00404-012-2391-6

    Article  PubMed  Google Scholar 

  19. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5(12):1–79

    CAS  PubMed  Google Scholar 

  20. Van Bruwaene S, De Win G, Miserez M (2009) How much do we need experts during laparoscopic suturing training? Surg Endosc 23(12):2755–2761. doi:10.1007/s00464-009-0498-z

    Article  PubMed  Google Scholar 

  21. Alcalay M, Cosson M, Livneh M, Lucot JP, Von Theobald P (2011) Trocarless system for mesh attachment in pelvic organ prolapse repair–1-year evaluation. Int Urogynecol J 22(5):551–556. doi:10.1007/s00192-010-1349-0

    Article  PubMed  Google Scholar 

  22. Geller EJ, Parnell BA, Dunivan GC (2012) Robotic vs abdominal sacrocolpopexy: 44-month pelvic floor outcomes. Urology 79(3):532–536. doi:10.1016/j.urology.2011.11.025

    Article  PubMed  Google Scholar 

  23. Ficarra V, Wiklund PN, Rochat CH, Dasgupta P, Challacombe BJ, Sooriakumaran P, Siemer S, Suardi N, Novara G, Mottrie A (2013) The European Association of Urology Robotic Urology Section (ERUS) survey of robot-assisted radical prostatectomy (RARP). BJU Int 111(4):596–603. doi:10.1111/bju.12100

    Article  PubMed  Google Scholar 

  24. Lumen N, Van Praet C, De Troyer B, Fonteyne V, Oosterlinck W, Decaestecker K, Mottrie A (2013) Safe introduction of robot-assisted radical prostatectomy after a training program in a High-Volume Robotic Centre. Urol Int. doi:10.1159/000350652

    PubMed  Google Scholar 

  25. Ploumidis A, Spinoit AF, Naeyer GD, Schatteman P, Gan M, Ficarra V, Volpe A, Mottrie A (2013) Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: Surgical Technique and Outcomes at a Single High-volume Institution. Eur Urol. doi:10.1016/j.eururo.2013.05.054

    Google Scholar 

  26. Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD (2011) Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol 118(5):1005–1013. doi:10.1097/AOG.0b013e318231537c

    Article  PubMed  Google Scholar 

  27. Mueller ER, Kenton K, Tarnay C, Brubaker L, Rosenman A, Smith B, Stroupe K, Bresee C, Pantuck A, Schulam P, Anger JT (2012) Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS). Contemp Clin Trials 33(5):1011–1018. doi:10.1016/j.cct.2012.05.007

    Article  CAS  PubMed  Google Scholar 

  28. Yu HY, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC (2012) Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 187(4):1392–1398. doi:10.1016/j.juro.2011.11.089

    Article  PubMed  Google Scholar 

  29. Elliott CS, Hsieh MH, Sokol ER, Comiter CV, Payne CK, Chen B (2012) Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis. J Urol 187(2):638–643. doi:10.1016/j.juro.2011.09.160

    Article  PubMed  Google Scholar 

  30. Geller EJ, Lin FC, Matthews CA (2013) Analysis of robotic performance times to improve operative efficiency. J Minim Invasive Gynecol 20(1):43–48. doi:10.1016/j.jmig.2012.08.774

    Article  PubMed  Google Scholar 

  31. Akl MN, Long JB, Giles DL, Cornella JL, Pettit PD, Chen AH, Magtibay PM (2009) Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc 23(10):2390–2394. doi:10.1007/s00464-008-0311-4

    Article  PubMed  Google Scholar 

  32. Awad N, Mustafa S, Amit A, Deutsch M, Eldor-Itskovitz J, Lowenstein L (2013) Implementation of a new procedure: laparoscopic versus robotic sacrocolpopexy. Arch Gynecol Obstet 287(6):1181–1186. doi:10.1007/s00404-012-2691-x

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department Development and Regeneration, Faculty of Medicine & Pelvic Floor Unit, University Hospitals, KU Leuven, 3000, Leuven, Belgium

    Jan Deprest & Frank Van der Aa

  2. Department of Obstetrics and Gynaecology, 1st Medical Faculty of Charles University and Hospital Na Bulovce, Prague, Czech Republic

    Ladislav Krofta

  3. Department of Obstetrics and Gynaecology, St Lucas Hospital, Bruges, Belgium

    Filip Claerhout

  4. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands

    Jan-Paul Roovers

  5. Department of Obstetrics and Gynaecology, Isala Hospital, Dokter van Heesweg 2, Zwolle, The Netherlands

    Jan Den Boon

  6. Reinier de Graaf Hospital, Reinier de Graafweg 3-11, Delft, The Netherlands

    Alfredo L. Milani

Authors
  1. Jan Deprest
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ladislav Krofta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank Van der Aa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alfredo L. Milani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Den Boon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Filip Claerhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan-Paul Roovers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Deprest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deprest, J., Krofta, L., Van der Aa, F. et al. The challenge of implementing laparoscopic sacrocolpopexy. Int Urogynecol J 25, 1153–1160 (2014). https://doi.org/10.1007/s00192-014-2398-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2398-6

Keywords

Search

Navigation