Abstract
Introduction
Surgical repair of pelvic organ prolapse is one of the most frequent gynecological procedures, and its frequency is expected to increase as the population is gradually aging. Mesh use in urogynecological surgery should be limited because of important and life-treating complications. Sacral mesh-less and lateral procedures have been described as safe and effective to treat apical compartment prolapse. In this video, we describe a new laparoscopic mesh-less cervicopexy in women with symptomatic uterovaginal prolapse who did not desire uterine preservation.
Methods
Eleven women with symptomatic uterovaginal prolapse [stage 2 or higher according to the Pelvic Organ Prolapse Quantitative (POP-Q) classification system] underwent laparoscopic mesh-less cervicopexy to the sacrum and transverse fascia between May 2018 and June 2019. We performed application of the right uterosacral ligament starting from the sacrum and two semicontinous sutures including the transverse fascia, round ligament, prevescical peritoneum, pubocervical fascia and cervix that were subsequently knotted.
Results
At 6-month follow-up, the objective success rate for apical prolapse (POP-Q score C > −1) was 90.9% (10/11 women). Only one woman presented stage 3 apical prolapse recurrence with vaginal buldge.
Conclusion
Laparoscopic mesh-less cervicopexy for uterovaginal prolapse seems to be a feasible surgical technique at 6-month follow-up.
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References
Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. https://doi.org/10.1016/S0029-7844(97)00058-6.
Mahran MA, Herath RP, Sayed AT, Oligbo N. Laparoscopic management of genital prolapse. Arch Gynecol Obstet. 2011;283:1015–20. https://doi.org/10.1007/s00404-010-1822-5.
Maher C, Feiner B, Baessler K, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10:CD012376. https://doi.org/10.1002/14651858.CD012376.www.cochranelibrary.com.
Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, et al. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J. 2017;28:1685–93. https://doi.org/10.1007/s00192-017-3327-2.
Mereu L, Dalpra F, Terreno E, et al. Mini-laparoscopic repair of apical pelvic organ prolapse (POP) by lateral suspension with mesh. Facts, views Vis ObGyn. 2018;10:139–45.
Szymczak P, Grzybowska ME, Wydra DG. Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature. Neurourol Urodyn. 2019;38:2031–50. https://doi.org/10.1002/nau.24115.
Seracchioli R, Raimondo D, Arena A, et al. Laparoscopic mesh-less cervicosacropexy for uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2018;24:399–403. https://doi.org/10.1097/SPV.0000000000000464.
Ercoli A, Campagna G, Delmas V, et al. Anatomical insights into sacrocolpopexy for multicompartment pelvic organ prolapse. Neurourol Urodyn. 2016;35:813–8. https://doi.org/10.1002/nau.22806.
Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10–7. https://doi.org/10.1016/S0002-9378(96)70243-0.
Mueller MG, Jacobs KM, Mueller ER, et al. Outcomes in 450 women after minimally invasive abdominal sacrocolpopexy for pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2016;22:267–71. https://doi.org/10.1097/SPV.0000000000000269.
Bajzak KI, Green IC, Jacobs VR, et al. AAGL practice report: practice guidelines for laparoscopic subtotal/supracervical hysterectomy (LSH). J Minim Invasive Gynecol. 2014;21:9–16. https://doi.org/10.1016/j.jmig.2013.08.001.
Rogers RG, Pauls RN, Thakar R, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn. 2018;37:1220–40.
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C.P. First Surgeon, Reviewing; A.A. Writing, Original draft preparation; P.S. Conceptualization, Editing; D.R. Writing, Editing; R.S. Supervision, Editing
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Paolo, C., Alessandro, A., Salucci, P. et al. Laparoscopic cervicopexy for correction of apical genital prolapse in 10 steps: a pilot study. Int Urogynecol J 32, 1313–1316 (2021). https://doi.org/10.1007/s00192-020-04536-6
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DOI: https://doi.org/10.1007/s00192-020-04536-6