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Kakinuma T, Kakinuma K, Ueyama K, Shinohara T, Okamoto R, Imai K, Takeshima N, Yanagida K, Ohwada M. Mid-term outcomes of laparoscopic vaginal stump–round (Kakinuma method) and stump–uterosacral (Shull method) ligament fixation for pelvic organ prolapse: A retrospective comparative study. BMC Surg 2024; 24:137. [PMID: 38711094 PMCID: PMC11071197 DOI: 10.1186/s12893-024-02429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) using mesh are popular approaches for treating pelvic organ prolapse (POP). However, it is not uncommon that native tissue repair (NTR) should be presented as an option to patients who are expected to have extensive intraperitoneal adhesion or patients for whom LSC or RSC is difficult owing to various risk factors. Laparoscopic vaginal stump-uterosacral ligament fixation (Shull method) has been introduced as a method for NTR in case of POP. However, effective repair using this surgical procedure may not be possible in severe POPs. To solve the problems of the Shull method, we devised the laparoscopic vaginal stump-round ligament fixation (Kakinuma method) in which the vaginal stump is fixed to the uterine round ligament, a histologically strong tissue positioned anatomically higher than the uterosacral ligament. This study aimed to retrospectively and clinically compare the two methods. METHODS Of the 78 patients who underwent surgery for POP between January 2017 and June 2022 and postoperative follow-up for at least a year, 40 patients who underwent the Shull method (Shull group) and 38 who underwent the Kakinuma method (Kakinuma group) were retrospectively analyzed. RESULTS No significant differences were observed between the two groups in patient background variables such as mean age, parity, body mass index, and POP-Q stage. The mean operative duration and mean blood loss in the Shull group were 140.5 ± 31.7 min and 91.3 ± 96.3 ml, respectively, whereas the respective values in the Kakinuma group were 112.2 ± 25.3 min and 31.4 ± 47.7 ml, respectively. Thus, compared with the Shull group, the operative duration was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.003) in the Kakinuma group. Recurrence was observed in six patients (15.0%) in the Shull group and two patients (5.3%) in the Kakinuma group. Hence, compared with the Shull group, recurrence was significantly less in the Kakinuma group (P = 0.015). No patients experienced perioperative complications in either group. CONCLUSIONS The results suggest that the Kakinuma method can serve as a novel and viable NTR procedure for POP.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan.
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kyouhei Ueyama
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Takumi Shinohara
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Rora Okamoto
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara-City, 329-2763, Tochigi, Japan
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Wang W, Liang H, Yu H, Rong C, Dong Y, Xue M, Liu X, Liang J, Ling B. Mesh-less laparoscopic extraperitoneal linear suspension treatment of vaginal vault prolapse. Eur J Obstet Gynecol Reprod Biol 2024; 296:275-279. [PMID: 38493551 DOI: 10.1016/j.ejogrb.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/28/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To report the results of a mesh-less laparoscopic extraperitoneal linear suspension technique for the treatment of post-hysterectomy vaginal vault prolapse (PHVP). STUDY DESIGN A retrospective observational study was conducted collecting medical records of 41 patients with symptomatic PHVP treated between November 2017 to November 2019 in Gynecologic department of China-Japan Friendship Hospital. All patients had Pelvic Organ Prolapse Quantification (POP-Q) scores indicating stage 3-4 PHVP and underwent mesh-less laparoscopic extraperitoneal linear suspension.The primary outcome was the subjective satisfaction rate based on responses to validated questionnaires. The secondary outcomes were the objective anatomical cure rate based on POP-Q scores and complication rates. All listed parameters were determined before the surgery and at control examinations in 1 year and 3 years after the treatment. RESULTS The operation was completed successfully without serious complications in all patients. Mean operation time was 53.8 mins. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.The subjective satisfaction rates were 100 % (41/41) and 95 % (38/40) at 1 year and 3 years after surgery. The objective cure rates were 100 % (41/41) and 97.5 % (39/40) at 1 year and 3 years after surgery, respectively. During the follow-up, none of the patients experienced suture exposure, infection, chronic pelvic pain, or other related complications. CONCLUSION The mesh-less laparoscopic extraperitoneal linear suspension technique avoids the use of implantable synthetic mesh. It has been shown to lead to favorable postoperative outcomes, considerable patient contentment, and low complication rates. It offers a new, cost-effective treatment option for PHVP patients.
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Affiliation(s)
- Wenhui Wang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Haiyan Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huan Yu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chunhong Rong
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuxiao Dong
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ming Xue
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaodie Liu
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Jing Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China.
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Maluenda A, Santis-Moya F, Arévalo D, Pohlhammer D, Blumel B, Guzmán-Rojas R, Pizarro-Berdichevsky J. Levator Ani Avulsion in Ultrasound Increases Recurrence in Sacrospinous Fixation. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:505-510. [PMID: 38019478 DOI: 10.1097/spv.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
IMPORTANCE Pelvic floor translabial ultrasound (TLUS) can identify levator ani muscle (LAM) avulsion and ballooning, which some studies have shown to be possible risk factors for prolapse recurrence. Our group uses TLUS to counsel patients preoperatively. If any of these risk factors exist, we offer sacrocolpopexy over vaginal repair. However, some patients, even though they have these possible risk factors, prefer to undergo vaginal surgery. OBJECTIVE The objective of this study was to determine if TLUS LAM avulsion and/or ballooning are risk factors for composite outcome recurrence in patients undergoing sacrospinous ligament fixation for pelvic organ prolapse. STUDY DESIGN This was a retrospective observational study. All patients with vaginal apical repair with sacrospinous ligament fixation with preoperative TLUS were included. Demographics, clinical characteristics, and follow-up were analyzed. Multivariable logistic regression analysis was performed for composite outcome that included TLUS risk factors, age, Pelvic Organ Prolapse Quantification System measurements and stage, and variables with P < 0.1 in the univariate analysis. RESULTS Eighty-two patients were included. All patients had symptomatic vaginal bulge; 65.4% had stage III prolapse. Concomitant hysterectomy was performed in 54.3%. Median follow-up was 20 months (interquartile range, 8-35 months); 19.8% had LAM avulsion, and 43.2% had ballooning. Anatomic recurrence rate was 23.5%, symptomatic was 22.2%, and reoperation was 1.2%. The composite recurrence rate was 29.6%. In the multivariable logistic regression analysis, unilateral/bilateral avulsion in TLUS was found to be a significant risk factor for composite outcome with an odds ratio of 4.33 (confidence interval, 1.219-15.398; P = 0.023). CONCLUSIONS Composite outcome of recurrence in our study was 29.6%. Avulsion on TLUS increased the risk of recurrence of pelvic organ prolapse by fourfold.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Guzmán-Rojas
- Departamento de Ginecología y Obstetricia, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo
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Zoorob D, Shuffle E, Matkins J, Harmanli O. Transvaginally Adjustable Apical Suspension and Compartment-Specific Tensioning in Vaginal Natural-Orifice Transluminal Endoscopic Surgery Sacrocolpopexy: Cadaveric and Live Patient Experience. J Gynecol Surg 2024; 40:116-122. [PMID: 38690153 PMCID: PMC11057538 DOI: 10.1089/gyn.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Objective This article provides a systematic approach to performing a vaginal natural-orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) to create an anatomically aligned vaginal axis, an intraoperatively adjustable apical suspension, and variable compartment tensioning. Methods The technique presented for vNOTES SCP focuses on: (1) retroperitoneal tunneling; (2) direct sacrum access below the S-1 level, using uterosacral-ligament guidance; (3) transvaginal tensioning of the mesh to ensure both adequate vaginal length and cuff elevation using the DZOH apical-suspension technique; (4) circumvention of intrapelvic laparoscopic suturing; and (5) near-total peritoneal coverage of the mesh arms. Results This detailed description of a successful novel technique to perform vNOTES SCP was based on cadaveric experience as well as in live patients that is reproducible on living patients. Conclusions This apical suspension technique for vNOTES SCP may be a viable, reproducible, safe, and efficient transvaginal alternative to the commonly practiced minimally invasive approaches that involve abdominal-port placements. (J GYNECOL SURG 40:116).
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Affiliation(s)
- Dani Zoorob
- UroGynecology Division, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA
| | - Eric Shuffle
- Department of Obstetrics and Gynecology, ProMedica Health System, Toledo, Ohio, USA
| | - Jay Matkins
- Department of Obstetrics and Gynecology, Atrium Health, Charlotte, North Carolina, USA
| | - Oz Harmanli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Ashmore S, Kenton K, Das D, Bretschneider CE. Obesity and Reconstructive Pelvic Surgery: An ACS NSQIP Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:286-292. [PMID: 38484244 DOI: 10.1097/spv.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS). OBJECTIVE This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS. STUDY DESIGN This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared). RESULTS A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery. CONCLUSION Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.
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Affiliation(s)
- Sarah Ashmore
- From the Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago
| | - Kimberly Kenton
- From the Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago
| | - Deepanjana Das
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern Medicine, Chicago, IL
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern Medicine, Chicago, IL
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Oh S, Shin JH. Outcomes of robotic sacrocolpopexy. Obstet Gynecol Sci 2023; 66:509-517. [PMID: 37461208 PMCID: PMC10663399 DOI: 10.5468/ogs.23073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 11/22/2023] Open
Abstract
This review aimed to summarize the complications and surgical outcomes of robot-assisted sacrocolpopexy. Nineteen original articles on 1,440 robotic sacrocolpopexies were reviewed, and three systematic reviews and meta-analyses were summarized in terms of intraoperative, perioperative, postoperative, and/or surgical outcomes. Robotic sacrocolpopexy has demonstrated low overall complication rates and favorable surgical outcomes. Nevertheless, long-term follow-up outcomes regarding objective and/or subjective prolapse recurrence, reoperation rates, and mesh-related complications remain unclear. Further research is required to demonstrate whether the robotic approach for sacrocolpopexy is feasible or can become the modality of choice in the future when performing sacrocolpopexy.
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Affiliation(s)
- Sumin Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul,
Korea
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Ciortea R, Roman MP, Măluțan AM, Bucuri CE, Ormindean CM, Nati ID, Mihu D. Comparison of laparoscopic sacrocolpopexy with vaginal reconstructive procedures and abdominal sacrocolpopexy for the surgical management of vaginal vault prolapse: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1269214. [PMID: 37766917 PMCID: PMC10520704 DOI: 10.3389/fmed.2023.1269214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Vaginal vault prolapse, also known as apical prolapse, is a distressing condition that may affect women following hysterectomy, necessitating surgical intervention when conservative measures prove ineffective. The surgical management of apical compartment prolapse includes procedures such as laparoscopic sacrocolpopexy (LSCP), abdominal sacrocolpopexy (ASCP) or vaginal reconstructive procedures (VRP). This systematic review and meta-analysis aims to compare the outcomes of these interventions. Methods A comprehensive search of electronic databases was conducted to identify eligible studies. Fourteen studies comprising a total of 1,289 women were included. The selected studies were analyzed to evaluate outcomes such as duration of surgery, length of hospital stay, blood loss, complication rates, and patient satisfaction. Results LSCP did not demonstrate significant advantages over VRP in terms of perioperative or long-term outcomes. However, when compared to ASCP, LSCP showed shorter hospital stay, reduced blood loss, decreased postoperative pain, and lower rates of ileus. Discussion This systematic review contributes to evidence-based decision-making for the surgical treatment of vaginal vault prolapse. While LSCP did not exhibit substantial benefits over VRP, it emerged as a preferable option compared to ASCP due to shorter hospital stays and reduced postoperative complications. The findings from this study provide valuable insights for clinicians and patients in selecting the most appropriate surgical approach for vaginal vault prolapse. However, future research should focus on long-term follow-ups, standardizing outcomes, and outcome measures, and evaluating cost-effectiveness to further enhance clinical practice.
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Affiliation(s)
- Răzvan Ciortea
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Maria-Patricia Roman
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Andrei Mihai Măluțan
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Carmen Elena Bucuri
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Military Emergency Hospital “Dr. Constantin Papilian”, Cluj-Napoca, Romania
| | - Cristina Mihaela Ormindean
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Ionel Daniel Nati
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Dan Mihu
- Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 2nd Obstetrics and Gynaecology Clinical Section, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
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Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev 2023; 7:CD012376. [PMID: 37493538 PMCID: PMC10370901 DOI: 10.1002/14651858.cd012376.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Apical vaginal prolapse is the descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available, but there are no guidelines to recommend which is the best. OBJECTIVES To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings and ClinicalTrials.gov (searched 14 March 2022). SELECTION CRITERIA We included randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site). MAIN RESULTS We included 59 RCTs (6705 women) comparing surgical procedures for apical vaginal prolapse. Evidence certainty ranged from very low to moderate. Limitations included imprecision, poor methodology, and inconsistency. Vaginal procedures compared to sacral colpopexy for vault prolapse (seven RCTs, n=613; six months to f four-year review) Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.31, 95% confidence interval (CI) 1.27 to 4.21, 4 RCTs, n = 346, I2 = 0%, moderate-certainty evidence). If 8% of women are aware of prolapse after sacral colpopexy, 18% (10% to 32%) are likely to be aware after vaginal procedures. Surgery for recurrent prolapse was more common after vaginal procedures (RR 2.33, 95% CI 1.34 to 4.04; 6 RCTs, n = 497, I2 = 0%, moderate-certainty evidence). The confidence interval suggests that if 6% of women require repeat prolapse surgery after sacral colpopexy, 14% (8% to 25%) are likely to require it after vaginal procedures. Prolapse on examination is probably more common after vaginal procedures (RR 1.87, 95% CI 1.32 to 2.65; 5 RCTs, n = 422; I2 = 24%, moderate-certainty evidence). If 18% of women have recurrent prolapse after sacral colpopexy, between 23% and 47% are likely to do so after vaginal procedures. Other outcomes: Stress urinary incontinence (SUI) was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I2 = 0%, moderate-certainty evidence). The effect of vaginal procedures on dyspareunia was uncertain (RR 3.44, 95% CI 0.61 to 19.53; 3 RCTs, n = 106, I2 = 65%, low-certainty evidence). Vaginal hysterectomy compared to sacral hysteropexy/cervicopexy (six RCTS, 554 women, one to seven year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.01 95% CI 0.10 to 9.98; 2 RCTs, n = 200, very low-certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 0.85, 95% CI 0.47 to 1.54; 5 RCTs, n = 403; I2 = 9%, low-certainty evidence). Prolapse on examination- there was little or no difference between the groups for this outcome (RR 0.78, 95% CI 0.54 to 1.11; 2 RCTs n = 230; I2 = 9%, moderate-certainty evidence). Vaginal hysteropexy compared to sacral hysteropexy/cervicopexy (two RCTs, n = 388, 1-four-year review) Awareness of prolapse - No difference between the groups for this outcome (RR 0.55 95% CI 0.21 to 1.44; 1 RCT n = 257, low-certainty evidence). Surgery for recurrent prolapse - No difference between the groups for this outcome (RR 1.34, 95% CI 0.52 to 3.44; 2 RCTs, n = 345; I2 = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 0.99, 95% CI 0.83 to 1.19; 2 RCTs n =367; I2 =9%, moderate-certainty evidence). Vaginal hysterectomy compared to vaginal hysteropexy (four RCTs, n = 620, 6 months to five-year review) Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.0 95% CI 0.44 to 2.24; 2 RCTs, n = 365, I2 = 0% moderate-quality certainty evidence). Surgery for recurrent prolapse - There may be little or no difference between the groups for this outcome (RR 1.32, 95% CI 0.67 to 2.60; 3 RCTs, n = 443; I2 = 0%, moderate-certainty evidence). Prolapse on examination- There were little or no difference between the groups for this outcome (RR 1.44, 95% CI 0.79 to 2.61; 2 RCTs n =361; I2 =74%, low-certainty evidence). Other outcomes: Total vaginal length (TVL) was shorter after vaginal hysterectomy (mean difference (MD) 0.89cm 95% CI 0.49 to 1.28cm shorter; 3 RCTs, n=413, low-certainty evidence). There is probably little or no difference between the groups in terms of operating time, dyspareunia and stress urinary incontinence. Other analyses There were no differences identified for any of our primary review outcomes between different types of vaginal native tissue repair (4 RCTs), comparisons of graft materials for vaginal support (3 RCTs), pectopexy versus other apical suspensions (5 RCTs), continuous versus interrupted sutures at sacral colpopexy (2 RCTs), absorbable versus permanent sutures at apical suspensions (5 RCTs) or different routes of sacral colpopexy. Laparoscopic sacral colpopexy is associated with shorter admission time than open approach (3 RCTs) and quicker operating time than robotic approach (3 RCTs). Transvaginal mesh does not confer any advantage over native tissue repair, however is associated with a 17.5% rate of mesh exposure (7 RCTs). AUTHORS' CONCLUSIONS Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, and postoperative SUI than a variety of vaginal interventions. The limited evidence does not support the use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. There were no differences in primary outcomes for different routes of sacral colpopexy. However, the laparoscopic approach is associated with a shorter operating time than robotic approach, and shorter admission than open approach. There were no significant differences between vaginal hysteropexy and vaginal hysterectomy for uterine prolapse nor between vaginal hysteropexy and abdominal hysteropexy/cervicopexy. There were no differences detected between absorbable and non absorbable sutures however, the certainty of evidence for mesh exposure and dyspareunia was low.
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Affiliation(s)
- Christopher Maher
- Wesley and Royal Brisbane and Women's Hospitals, Brisbane, Australia
| | - Ellen Yeung
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nir Haya
- Rambam Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Alex Mowat
- Greenslopes Hospital, Brisbane, Australia
| | | | - Kaven Baessler
- Franziskus and St Joseph Hospitals Berlin, Berlin, Germany
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Kakinuma T, Kaneko A, Kakinuma K, Imai K, Takeshima N, Ohwada M. New native tissue repair for pelvic organ prolapse: Medium-term outcomes of laparoscopic vaginal stump–round ligament fixation. World J Clin Cases 2023; 11:3457-3463. [PMID: 37383910 PMCID: PMC10294204 DOI: 10.12998/wjcc.v11.i15.3457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) is a new and widely used approach; however, ever since the United States Food and Drug Administration warned against the use of surgical mesh, repairs performed using patients’ tissues [i.e. native tissue repair (NTR)] instead of mesh have attracted much attention. At our hospital, laparoscopic sacrocolpopexy (the Shull method) was introduced in 2017. However, patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.
AIM To validate a new NTR treatment for POP, we examined patients undergoing laparoscopic vaginal stump–round ligament fixation (the Kakinuma method).
METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for > 12 mo after surgery. We retrospectively examined surgical outcomes for surgery duration, blood loss, intraoperative complications, and incidence of recurrence. The Kakinuma method involves round ligament suturing and fixation on both sides, effectively lifting the vaginal stump after laparoscopic hysterectomy.
RESULTS The patients’ mean age was 66.5 ± 9.1 (45-82) years, gravidity was 3.1 ± 1.4 (2-7), parity was 2.5 ± 0.6 (2-4) times, and body mass index was 24.5 ± 3.3 (20.9-32.8) kg/m2. According to the POP quantification stage classification, there were 8 patients with stage II, 11 with stage III, and 11 with stage IV. The mean surgery duration was 113.4 ± 22.6 (88-148) min, and the mean blood loss was 26.5 ± 39.7 (10-150) mL. There were no perioperative complications. None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge. No cases of POP recurrence were observed 12 mo after the operation.
CONCLUSION The Kakinuma method, similar to conventional NTR, may be an effective treatment for POP.
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Affiliation(s)
- Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare, Nasushiobara 329-2763, Japan
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Glass Clark S, Dang R, Bonnet S, Zyczynski HM, Giugale L. Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:404-409. [PMID: 36331917 DOI: 10.1097/spv.0000000000001273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Although anatomic level of mesh attachment to the sacrum varied during minimally invasive sacrocolpopexy with a large proportion above S1, this was not associated with pelvic organ prolapse recurrence. OBJECTIVE This study aimed to describe the anatomic level of sacral mesh attachment and its association with prolapse recurrence after minimally invasive sacrocolpopexy. STUDY DESIGN This study included a retrospective cohort of women who underwent minimally invasive sacrocolpopexy with subsequent abdominal and pelvic imaging (magnetic resonance imaging or computed tomography) between 2010 and 2019 at a single academic institution. Anatomic level of attachment was determined by a radiologist. Prolapse recurrence was defined as a composite of self-reported bulge symptoms, any prolapse measure beyond the hymen, and any retreatment with pessary or surgery. χ 2 Tests were used for comparative outcomes. RESULTS Analyses included 212 women. The mean ± SD age was 58.8 ± 9.9 years, the majority have preoperative stage III/IV prolapse (81.1%), and the median follow-up was 269 days (interquartile range, 57-825 days). Mesh was attached using titanium tacks (n = 136 [64.2%]) and suture (n = 76 [35.8%]) at the level of the L5-S1 intervertebral space (n = 113 [53.3%]) or overlying S1 (n = 89 [42.0%]).The surgical approach was significantly associated with attachment location with a greater proportion of laparoscopy cases demonstrating mesh attachment above S1 (85 [62.5%] vs robotically, 30 [39.5%]; P < 0.01). Dichotomized level of attachment was not associated with composite prolapse recurrence (above S1, n = 18 [22.2%] vs below S1, n = 24 [24.7%]; P = 0.69) or any compartment recurrence ( P ≥ 0.36). CONCLUSIONS Mesh was primarily attached to the anterior longitudinal ligament at the level of the L5-S1 intervertebral space or S1. Level of mesh attachment was not associated with composite prolapse recurrence.
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Affiliation(s)
| | - Rachel Dang
- Department of Obstetrics, Gynecology and Reproductive Sciences
| | - Sarah Bonnet
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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11
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Meirmanova A, Omarova G, Kurmanova A, Begniyazova Z, Yuldasheva A. Surgical management of genital prolapse and combined gynecological pathologies in women: A meta-analysis. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
<b>Introduction:</b> Prolapse can be fixed using a variety of surgical procedures. The goal of the present study was to examine the current literature on various surgical techniques for treating female genital organ prolapse.<br />
<b>Methods:</b> The PubMed and Medline databases were explored for pertinent literature up through August 2022 for this meta-analysis. The terms [surgery] AND [management] AND [genital prolapse OR gynaecological diseases] AND [randomised control studies OR randomised control trials] were used as search criteria. The studies that met the inclusion criteria were considered qualified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Cochrane handbook of “Systematic reviews of interventions” was used for risk of bias assessment.<br />
<b>Results:</b> The investigations found significant difference in the heterogeneity between the groups with a 76% I<sup>2</sup> value (p<0.00001). There was little variability among the six trials that examined robotic and laparoscopic therapy of prolapse (I<sup>2</sup>=0%, p=0.94). In six investigations, the odd ratio revealed no statistically significant difference between groups (1.05; 95% CI, 0.52, 2.12). However, generally there were no appreciable differences between robotic and laparoscopic treatment of female prolapse. There was a low-risk bias among the selected studies.<br />
<b>Conclusion:</b> According to this meta-analysis study, laparoscopic surgery performed better job of managing prolapse than abdominal surgery.
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Affiliation(s)
- Aliya Meirmanova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Gulzhakhan Omarova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Almagul Kurmanova
- Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, KAZAKHSTAN
| | - Zhanara Begniyazova
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
| | - Ainura Yuldasheva
- Department Obstetrics and Gynecology, Kazakh National Medical University, Almaty, KAZAKHSTAN
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12
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Oh S, Bae N, Cho HW, Park YJ, Kim YJ, Shin JH. Learning curves and perioperative outcomes of single-incision robotic sacrocolpopexy on two different da Vinci ® surgical systems. J Robot Surg 2023:10.1007/s11701-023-01541-x. [PMID: 36757563 DOI: 10.1007/s11701-023-01541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
This study aimed to report a single surgeon's early experience and learning curves of single-incision robotic sacrocolpopexy on two different robotic surgical platforms, namely, the single-site approach on da Vinci Xi® and single-port approach on da Vinci SP® surgical systems. This retrospective study included 123 consecutive cases of robotic sacrocolpopexy performed between June 2017 and June 2021 for the patients with Pelvic Organ Prolapse Quantification stage 2-4 symptomatic prolapse. First consecutive 57 cases were performed under the da Vinci Xi® system applying the single-site manner, whereas the following 66 cases were done under the da Vinci SP® system. The primary outcome was intraoperative and perioperative complication rates, and the secondary outcome was learning curve of single-incision robotic sacrocolpopexy under the two different robotic surgical platforms. Learning curves based on the operation time were obtained through cumulative sum analysis. The mean age of each group was 65.6 ± 8.7 years for single-site robotic sacrocolpopexy and 63.7 ± 7.6 years for the single-port one (p = 0.202). More than 80% of patients for each group had advanced prolapse stages and underwent concomitant total hysterectomy. The overall baseline characteristics did not differ significantly between groups. The median operation time for each group were 201.0 and 201.5 min, respectively. Both groups showed comparable perioperative outcomes in terms of operation time, intraoperative blood loss, and length of hospital stay. Intraoperative cystostomy rates were 1.8% and 3.0%, respectively, and revealed no statistical difference (p = 0.736). The learning curves were comparable, and the surgeon required less than 15 cases for both single-site and single-port robotic sacrocolpopexies to stabilize operation time. Comparable learning curves and favorable intraoperative and perioperative outcomes of single-incision robotic sacrocolpopexy using two different robotic surgical systems show that both are feasible options for robotic sacrocolpopexy.
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Affiliation(s)
- Sumin Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Nayoung Bae
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Yoon Jeong Park
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yong Jin Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
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Sato H, Otsuka S, Abe H, Miyagawa T. Medium-term risk of recurrent pelvic organ prolapse within 2-year follow-up after laparoscopic sacrocolpopexy. Gynecol Minim Invasive Ther 2023; 12:38-43. [PMID: 37025445 PMCID: PMC10071876 DOI: 10.4103/gmit.gmit_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 02/11/2023] Open
Abstract
Objective The present study was performed to determine the risk of recurrent pelvic organ prolapse (POP) within 2 years after laparoscopic sacrocolpopexy (LSC) in patients with uterovaginal prolapse. Materials and Methods A retrospective comparative study was performed in a population of 204 patients over a 2-year follow-up period following LSC with concomitant supracervical hysterectomy or uterine preservation at a single urological clinic between 2015 and 2019. The primary outcome was surgical failure following LSC in cases of POP, focusing on failures occurring before the 2ndyear of follow-up. Logistic regression analysis was used to determine the odds ratios (ORs) for surgical failure. Results The primary outcome, surgical failure in cases of POP, occurred 2 years after the initial surgery in 19 of the 204 patients (9.3%) (95% confidence interval [CI], 5.7% - 14.2%). Surgical failure was most common in the anterior compartment (n = 10, 4.9%), and further surgery was performed in seven of the patients with surgical failure (3.4%). The poor primary outcome was predicted by lysis of adhesions (OR, 7.5, 95% CI, 1.6-33.8, P = 0.008) and preoperative POP stage IV (OR, 3.5; 95% CI, 1.1-10.8, P = 0.03) on multivariable logistic regression analysis. Conclusion The overall rate of surgical failure following LSC in our cohort was 9.3% over the 2-year follow-up period after surgery, and preoperative prolapse stage IV was associated with a higher risk of recurrence.
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14
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Rusavy Z, Grinstein E, Gluck O, Abdelkhalek Y, Deval B. Long-term development of surgical outcome of laparoscopic sacrohysteropexy with anterior and posterior mesh extension. Int Urogynecol J 2023; 34:191-200. [PMID: 35416498 DOI: 10.1007/s00192-022-05102-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/14/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS 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. METHODS 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. RESULTS In total, 270 patients after LSH with a follow-up of up to 14.5 years were enrolled and divided into groups according to their last follow-up length: ≥ 1 year 242, ≥ 3 years 112, ≥ 5 years 76, ≥ 7 years 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. CONCLUSIONS 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.
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Affiliation(s)
- Zdenek Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France.
| | - Ehud Grinstein
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yara Abdelkhalek
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
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15
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Chan JCY, Yu CH, Go WW. Clinical outcomes and complications of laparoscopic sacrocolpopexy with versus without concomitant hysterectomy for pelvic organ prolapse in Hong Kong Chinese patients after median follow-up of 7 years. Int Urogynecol J 2023; 34:271-278. [PMID: 36394632 DOI: 10.1007/s00192-022-05403-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This retrospective cohort study is aimed at comparing outcomes and complications of laparoscopic sacrocolpopexy (LSC) with or without concomitant hysterectomy in the Hong Kong Chinese population. METHODS Women with stage II or above uterine or apical vault prolapse who underwent LSC with or without concomitant hysterectomy in a regional referral unit from 2007 to 2019 were included. The primary objectives were to compare the anatomical outcomes by pelvic organ prolapse quantification system (POP-Q) and recurrence of apical vault prolapse (≥stage II). The secondary objective was to compare the functional outcomes and complications. Anatomical recurrence and incidence of mesh exposure were analyzed using the Kaplan-Meier method. Cox proportional hazard regression was performed to identify risk factors of anatomical recurrence. RESULTS Seventy-six women were included for analysis. The recurrence rate of apical vault prolapse was 3.9% after a median follow-up time of 83 months (20-190 months). A significant reduction of POP-Q scores of three compartments in both groups of women were demonstrated (p<0.001). There was no difference between the two groups in terms of functional outcomes and complications. 6.6% of women developed mesh exposure. The time to recurrence of apical vault prolapse was shorter in women who had LSC with prior hysterectomy (p =0.019). No risk factors were identified for recurrence of apical vault prolapse. CONCLUSIONS Laparoscopic sacrocolpopexy with concomitant hysterectomy is comparable with LSC alone. The recurrence and complication rates are low. We suggest that LSC with concomitant hysterectomy might be offered to women with pelvic organ prolapse, with women's preference taken into account.
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Affiliation(s)
- Joyce Chung Yin Chan
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
| | - Chun Hung Yu
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
| | - Wing Wa Go
- Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong
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Glass Clark S, Shepherd JP, Sassani JC, Bonidie M. Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms. Int Urogynecol J 2023; 34:87-91. [PMID: 36282303 DOI: 10.1007/s00192-022-05391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. OBJECTIVE To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. METHODS Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. RESULTS The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5 ± 9.7, BMI 27.9 ± 4.7, and parity 2.5 ± 1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ = 32.1 min, p = 0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p > 0.05). On univariable analysis, costs were similar (Senhance $5368.31 ± 1486.89, DaVinci $5741.76 ± 1197.20, p = 0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p > 0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p = 0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. CONCLUSIONS Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.
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Affiliation(s)
- Stephanie Glass Clark
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan P Shepherd
- Department of Obstetrics & Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Jessica C Sassani
- Division of Urogynecology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Michael Bonidie
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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van Oudheusden AMJ, Eissing J, Terink IM, Vink MDH, van Kuijk SMJ, Bongers MY, Coolen ALWM. Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial. Int Urogynecol J 2023; 34:93-104. [PMID: 36112182 PMCID: PMC9483545 DOI: 10.1007/s00192-022-05350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). METHODS Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC (n=37) or ASC (n=37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. RESULTS We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0-17; ASC: IQR 0-0) on the "genital prolapse" domain of the Urogenital Distress Inventory in both groups (p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% (n = 11) in the LSC group and 84.6% (n = 11) in the ASC group (p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). CONCLUSIONS At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. TRIAL REGISTRATION Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, Jeroen Bosch Hospital, P.O. Box 90153, 5200, ME, 's-Hertogenbosch, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Josephine Eissing
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130, MB, Sittard-Geleen, The Netherlands
| | - Ivon M Terink
- Utrecht General Practice Training Institute, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maarten D H Vink
- Department of Gynecology and Obstetrics, Isala Medical Centre, P.O. Box 10400, 8000, GK, Zwolle, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology, Bergman Clinics, Marathon 1, 1213, PA, Hilversum, The Netherlands
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Cassadó J, Huguet E, Carmona A, Oteros B, Pessarrodona A, Porta O. Impact of Laparoscopic Prolapse Repair in the Levator Hiatus Area. J Minim Invasive Gynecol 2022; 29:1310-1316. [PMID: 35964943 DOI: 10.1016/j.jmig.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To determine whether laparoscopic surgery by sacrocolpopexy or sacrocervicopexy with posterior mesh attachment to levator ani to treat pelvic organ prolapse reduces the levator hiatus area, as measured by transperineal 3- and 4-dimensional ultrasound. The secondary objective was to assess the risk factors for prolapse recurrence. DESIGN This is a prospective cohort study. SETTING A university tertiary hospital. PATIENTS Women with symptomatic apical prolapse at a high risk of recurrence were included. High risk of recurrence was defined as age <60 years and levator injury (avulsion and/or ballooning) or stage III-IV prolapse Pelvic Organ Prolapse Quantification. INTERVENTIONS Women were treated with laparoscopic sacrocolpopexy or sacrocervicopexy. MEASUREMENTS AND MAIN RESULTS Women underwent clinical examination according to assessment by the Pelvic Organ Prolapse Quantification system and transperineal ultrasound for the levator hiatus area at Valsalva. We collected demographic, clinical, and ultrasound data before surgery from clinical records and performed a comparative analysis of the levator hiatus areas before and after surgery and univariate and multivariate analyses of the risk factors for recurrence. Among the 30 women who enrolled, the levator hiatus area at Valsalva decreased significantly after surgery by an average of 4.68 cm2 (p = .028). However, despite a recurrence rate of 13.3%, we found no risk factors associated with recurrence in either the univariate or the multivariate analyses. CONCLUSION Laparoscopic surgery by sacrocolpopexy or sacrocervicopexy for pelvic organ prolapse with mesh posterior attachment to levator ani significantly reduces the levator hiatus area measured by transperineal ultrasound. Further large-scale studies will be needed to confirm our results and identify risk factors for recurrence.
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Affiliation(s)
- Jordi Cassadó
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors).
| | - Eva Huguet
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | - Anna Carmona
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | - Beatriz Oteros
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
| | | | - Oriol Porta
- University Hospital Mútua Terrassa, Terrassa, Spain (all authors)
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Sato H, Otsuka S, Abe H, Tsukada S. Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan. J OBSTET GYNAECOL 2022; 42:3336-3341. [PMID: 36149283 DOI: 10.1080/01443615.2022.2125293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study was performed to investigate medium-term outcomes and reoperation rates after laparoscopic sacrocolpopexy (LSC). We examined 119 patients undergoing LSC for symptomatic pelvic organ prolapse (POP). The primary outcomes were subjective failure and anatomical failure at 2 years; a score ≥ 2 on question 3 of the PFDI-20 was considered to indicate subjective failure. POP-Q stage 2 or higher in any compartment was considered to indicate anatomical failure. Secondary outcomes were reoperations for POP recurrence, mesh-related complications, and stress urinary incontinence (SUI). The rates of subjective failure and anatomical failure were 4.2% (n = 5) and 9.2% (n = 11), respectively. Reoperations were needed in 13.4% (n = 16) of patients, including SUI with tape procedure in 7.5% (n = 9), POP recurrence in 4.2% (n = 5), and mesh-related complications in 1.6% (n = 2). The subjective failure rate at 2 years after LSC was acceptably low.Impact StatementWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has clinical efficacy equivalent to open sacrocolpopexy, and there is evidence that LSC involves less blood loss and shorter length of hospital stay. However, there is still insufficient evidence to assess medium-term outcomes after LSC in Japan.What the results of this study revealed? The findings of this study showed excellent medium-term rates of subjective failure (4.2%) and anatomical failure (8.4%) after LSC. We demonstrated that patients with persistent postoperative vaginal bulge (subjective failure) also had no improvement in postoperative urinary and colorectal symptoms. Our cohort had low rates of reoperation (13.4%) after LSC. The most common reoperations were for stress urinary incontinence (SUI) (7.5%), followed by pelvic organ prolapse (POP) recurrence (4.2%) and mesh-related complications (1.6%).What are the implications of these findings in clinical practice and/or further research? This study showed that LSC is a safe and effective treatment for POP. Comparative evaluation of anatomical outcomes and the patient's condition is required to understand the extent to which LSC positively impacts a woman's pelvic floor-related quality of life.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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20
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Morciano A, Caliandro D, Campagna G, Panico G, Giaquinto A, Fachechi G, Zullo MA, Tinelli A, Ercoli A, Scambia G, Cervigni M, Marzo G. Laparoscopic ventral rectopexy plus sacral colpopexy: continuous locked suture for mesh fixation. A randomized clinical trial. Arch Gynecol Obstet 2022; 306:1573-1579. [PMID: 35835920 DOI: 10.1007/s00404-022-06682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Laparoscopic ventral rectopexy (LVR) plus sacral colpopexy (LSC) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to rectal-mesh fixation during LVR with continuous locked suture. METHODS This is a prospective randomized double-blinded clinical trial enrolling 80 patients with severe POP and obstructed defecation syndrome (ODS) from November 2016 to January 2021. Patients underwent a "two-meshes" LSC plus LVR and were randomized, regarding rectal mesh fixation, in Group A (extracorporeal interrupted 0 delayed absorbable sutures) and Group B ("U-shaped" running locked 0 delayed absorbable suture). Our primary endpoints were the operative times (OT); the secondary endpoints were the incidence of anatomical failures, vaginal mesh erosions and surgical complications. RESULTS A total of 75 patients completed the study. Baseline characteristics were similar between the groups. Overall OT (156 vs 138 min; p < 0.05; treatment reduction of 11.5%) and LVR mesh fixation time (29 vs 16 min; p < 0.05; treatment reduction of 44%), resulted in significantly lower in Group B. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications. PGI-I, FSDS and Wexner questionnaires resulted significantly improved after surgery, without statistical differences between the studied surgical procedures. CONCLUSION Laparoscopic continuous locked 0 absorbable suture for LVR mesh fixation guaranteed a faster and effective alternative to multiple interrupted sutures. The significant OT reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LVR. CLINICAL TRIAL REGISTRATION NCT05254860 (13/02/2017).
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Affiliation(s)
- Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy. .,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy.
| | - Dario Caliandro
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Campagna
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Panico
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Alessia Giaquinto
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Giorgio Fachechi
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, University "Campus Biomedico", Rome, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Andrea Tinelli
- Department of Gynaecology and Obstetrics, "Veris Delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Alfredo Ercoli
- Department of Gynaecology and Obstetrics, Università Degli Studi Di Messina, Messina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mauro Cervigni
- Department of Urology, ICOT, Università "La Sapienza", Latina, Italy.,AIUG Research GroupAssociazione Italiana di UroGinecologia e del Pavimento Pelvico, Rome, Italy
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
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21
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Vargas Maldonado D, Yi J, Madsen AM. Laparoscopic Approach to Surgical Treatment of Pelvic Organ Prolapse. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Darlene Vargas Maldonado
- Department of Obstetrics and Gynecology, Division of Urogynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Johnny Yi
- Department of Medical and Surgical Gynecology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Annetta M. Madsen
- Department of Obstetrics and Gynecology, Division of Urogynecology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Cho EH, Shin ES, Kim SY. Laparoscopic sacrocolpopexy versus open abdominal sacrocolpopexy for pelvic organ prolapse repair: A retrospective cohort study. Ann Med Surg (Lond) 2022; 78:103852. [PMID: 35734693 PMCID: PMC9207108 DOI: 10.1016/j.amsu.2022.103852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Eun Hye Cho
- Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Eun Seo Shin
- Department of Obstetrics and Gynecology, School of Medicine, Jeju National University Hospital, Jeju Self-Governing Province, South Korea
| | - Sung Yob Kim
- Department of Obstetrics and Gynecology, School of Medicine, Jeju National University, Jeju Self-Governing Province, South Korea
- Corresponding author. Department of Obstetrics and Gynecology, Jeju National University, Aran 13gil 15(Ara-1Dong), Jeju city, Jeju Self-Governing Province, 63241, South Korea.
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23
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Capozzi VA, Scarpelli E, Armano G, Monfardini L, Celardo A, Munno GM, Fortunato N, Vagnetti P, Schettino MT, Grassini G, Labriola D, Loreto C, Torella M, Cianci S. Update of Robotic Surgery in Benign Gynecological Pathology: Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040552. [PMID: 35454390 PMCID: PMC9024779 DOI: 10.3390/medicina58040552] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Since the Food and Drug Administration's (FDA) approval in 2005, the application of robotic surgery (RS) in gynecology has been adopted all over the world. This study aimed to provide an update on RS in benign gynecological pathology by reporting the scientific recommendations and high-value scientific literature available to date. Materials and Methods: A systematic review of the literature was performed. Prospective randomized clinical trials (RCT) and large retrospective trials were included in the present review. Results: Twenty-two studies were considered eligible for the review: eight studies regarding robotic myomectomy, five studies on robotic hysterectomy, five studies about RS in endometriosis treatment, and four studies on robotic pelvic organ prolapse (POP) treatment. Overall, 12 RCT and 10 retrospective studies were included in the analysis. In total 269,728 patients were enrolled, 1721 in the myomectomy group, 265,100 in the hysterectomy group, 1527 in the endometriosis surgical treatment group, and 1380 patients received treatment for POP. Conclusions: Currently, a minimally invasive approach is suggested in benign gynecological pathologies. According to the available evidence, RS has comparable clinical outcomes compared to laparoscopy (LPS). RS allowed a growing number of patients to gain access to MIS and benefit from a minimally invasive treatment, due to a flattened learning curve and enhanced dexterity and visualization.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy; (E.S.); (G.A.); (L.M.)
- Correspondence:
| | - Elisa Scarpelli
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy; (E.S.); (G.A.); (L.M.)
| | - Giulia Armano
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy; (E.S.); (G.A.); (L.M.)
| | - Luciano Monfardini
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy; (E.S.); (G.A.); (L.M.)
| | - Angela Celardo
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Gaetano Maria Munno
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Nicola Fortunato
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Primo Vagnetti
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Maria Teresa Schettino
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Giulia Grassini
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Domenico Labriola
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Carla Loreto
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Marco Torella
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (G.M.M.); (N.F.); (P.V.); (M.T.S.); (G.G.); (D.L.); (C.L.); (M.T.)
| | - Stefano Cianci
- Department of Gynecologic Oncology and Minimally-Invasive Gynecologic Surgery, Università degli Studi di Messina, Policlinico G. Martino, 98124 Messina, Italy;
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24
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Trends in Same-Day Discharge Rate After Minimally Invasive Sacrocolpopexy and Propensity Score-Matched Analysis of Postoperative Complication Rates Using the National Surgical Quality Improvement Program Database. Female Pelvic Med Reconstr Surg 2022; 28:e22-e28. [PMID: 35272328 DOI: 10.1097/spv.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary aim of this study was to review trends in the same-day discharge (SDD) rate after minimally invasive sacrocolpopexy (MISCP). The secondary aim was to compare the composite 30-day postoperative complication rates between propensity score-matched SDD and admitted cohorts. METHODS This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2019. Patients who underwent MISCP were identified by Current Procedural Terminology codes. Concurrent hysterectomy, anterior or posterior repairs, rectopexy, and midurethral sling were also identified. Multivariable logistic regression and propensity score matching were performed. RESULTS A total of 12,762 MISCP patients were captured: 3,968 underwent MISCP only, 4,065 underwent MISCP with total laparoscopic hysterectomy, 734 underwent MISCP with laparoscopically assisted vaginal hysterectomy, and 3,995 underwent MISCP with laparoscopic supracervical hysterectomy. Overall, the SDD rate was 16.3%, with an increase from 12.3% in 2015 to 23.1% in 2019. Multivariable logistic regression showed that admitted patients were more likely to be older, to be of Black race, have an American Society of Anesthesiologists classification of 3 or 4, have hypertension requiring medication, have longer operative time, and have undergone concurrent anterior or posterior repair, rectopexy, or sling. After propensity score matching, the composite postoperative complication rates were similar between the 2 cohorts (5.7% vs 6.4%, P = 0.818). However, superficial surgical site infection was more likely in the SDD cohort (adjusted odds ratio, 2.3; P < 0.001) and blood transfusion in the admitted cohort (adjusted odds ratio, 11.9; P = 0.0.34). CONCLUSIONS The rate of SDD after MISCP seems to be increasing. Composite postoperative complication rates are similar between SDD and admitted cohorts.
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25
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Gluck O, Rusavy Z, Grinstein E, Abdelkhalek Y, Deval B. Effect of Age on Complications Rate and Surgical Outcomes in Women Undergoing Laparoscopic Sacrohysteropexy and Sacrocolpopexy. J Minim Invasive Gynecol 2022; 29:753-758. [PMID: 35123043 DOI: 10.1016/j.jmig.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To compare perioperative and long-term outcomes of laparoscopic sacrohysteropexy/sacrocolpopexy in different groups of age. DESIGN This was a retrospective cohort study. Patients were evaluated preoperatively and postoperatively (starting from 1 month after surgery, and then annually). SETTING The department of functional pelvic surgery & oncology a tertiary care center. PATIENTS All patients who underwent laparoscopic sacrohysteropexy/sacrocolpopexy, between July 2005 and December 2019 INTERVENTIONS: laparoscopic sacrohysteropexy/sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS The study population was divided into three groups, according to age at time of surgery: group 1- < 65, group 2- between 65-75, and group 3- > 75. The primary outcome was the rate of perioperative complications. The secondary outcome was the comparison of long-term results between the groups. Three hundred and thirty patients were included: 183 in group 1 (mean age 53.4±8.2), 92 patients in group 2 (mean age 69.2±2.9), and 55 patients in group 3 (mean age 79.3±.5). The overall perioperative complications rate (up to 30 days after surgery) was 5.7%. No differences between the groups in operative details and rates of perioperative complications were observed. During follow up period, 37 patients (11.2%) presented with prolapse recurrence (objective and/or subjective), the rates of prolapse recurrence, as well as long-term complications, were similar between 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). CONCLUSION Laparoscopic 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.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France.
| | - Zdenek Rusavy
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Ehud Grinstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Yara Abdelkhalek
- Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
| | - Bruno Deval
- Department of Functional Pelvic Surgery & Oncology, Geoffroy Saint-Hilaire, Ramsay Santé, Paris, France
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Prospective Evaluation of Laparoscopic Sacrocolpopexy with Concomitant Laparoscopic-Assisted Total Vaginal Hysterectomy. SURGERIES 2022. [DOI: 10.3390/surgeries3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.
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Sato H, Abe H, Ikeda A, Miyagawa T, Sato K, Tsukada S. Laparoscopic sacrocolpopexy for pelvic organ prolapse in the elderly: safety and outcomes. J OBSTET GYNAECOL 2022; 42:110-115. [PMID: 33890540 DOI: 10.1080/01443615.2020.1867968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Due to its low postoperative complication rate, vaginal surgery is the preferred intervention for pelvic organ prolapse (POP) in elderly patients. We aimed to assess outcomes and perioperative complication rates associated with laparoscopic sacrocolpopexy (LSC) in elderly women. We retrospectively reviewed the medical records of 74 consecutive patients [52 (70.3%) aged <75 years; 22 (29.7%) aged ≥75 years] with POP who underwent LSC between August 2015 and December 2017. We evaluated preoperative risks using the Charlson Comorbidity Index (CCI) and complications, using the Clavien-Dindo grading (CDG). No between-group differences were observed in CCI. CDG indicated fewer perioperative complications in patients aged >75 years. Anatomical success rates at 15 months were 95.5% and 90.4% in patients aged ≥75 and <75 years, respectively. LSC has a high anatomical correction rate and few perioperative complications regardless of age. Thus, the appropriate surgical intervention method would depend on the patient's health and comorbidities.IMPACT STATEMENTWhat is already known on this subject? Laparoscopic sacrocolpopexy (LSC) is a superior method to vaginal surgery because of its anatomical and functional outcomes, particularly regarding sexual activity.What do the results of this study add? In this single-center study with a 15-month follow-up, we demonstrated that LSC has a high anatomical correction rate and few perioperative complications regardless of age at the time of surgery. Furthermore, there was no significant difference in the rate of complications between the ≥75 and <75 years groups. Thus, LSC may be considered for women aged >75 years. However, in these elderly patients, the surgical method should be determined according to their health status and medical comorbidities.What the implications are of these findings for clinical practice and/or further research? Age should not be the basis for exclusion from laparoscopic procedures. Moreover, LSC is a suitable and valid option for elderly women with POP. As the study population consisted of a homogenous group of Japanese women, it lacks generalisability. Studies evaluating these outcomes are required in other populations.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Atsushi Ikeda
- Department of Urology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi, Medical University Saitama Medical Center, Saitama, Japan
| | - Katsuhiko Sato
- Department of Urology, Eastern Oomiya Medical Center, Saitama, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Kotani Y, Murakamsi K, Kai S, Yahata T, Kanto A, Matsumura N. Comparison of Surgical Results and Postoperative Recurrence Rates by Laparoscopic Sacrocolpopexy with Other Surgical Procedures for Managing Pelvic Organ Prolapse. Gynecol Minim Invasive Ther 2021; 10:221-225. [PMID: 34909379 PMCID: PMC8613493 DOI: 10.4103/gmit.gmit_127_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/10/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: Pelvic organ prolapse (POP) is relatively high for a gynecologic disease. Laparoscopic sacrocolpopexy (LSC) is currently the main surgical option for managing POP. The priority of the surgical treatment is preventing recurrence after the surgery. We presented the surgical outcome and recurrence rate of LSC and compared the data of LSC with that of other surgical procedures for managing POP to examine the effectiveness of LSC over other them. Materials and Methods: We compared the results of 138 cases of LSC with other conventional procedures, namely 30 cases of total vaginal hysterectomy (TVH) combined with colporrhaphy anterior and posterior, 66 cases of the Manchester operation, and 68 cases of colpocleisis. We compared the age, body mass index, operative time, blood loss volume, postoperative hospital stay duration, rate of complications, recurrence rate, reoperation rate, and the cumulative recurrence rate after 10 years. Results: The complication rate of LSC, TVH, the Manchester operation, and colpocleisis was 2.2%, 3.3%, 3.0%, and 4.4%; the recurrence rate 2.8%, 3.5%, 4.5%, and 8.7%; and the cumulative recurrence rate after 10 years 3.7%, 4.6%, 8.8%, and 18.2%. There was no significant difference between LSC and the other three groups. Conclusion: LSC seems to be an effective surgical option that requires a higher skill level than other surgical methods and has a longer operative time, lesser operative invasion, and a lower long-term recurrence rate. We will actively recommend LSC to those when appropriate.
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Affiliation(s)
- Yasushi Kotani
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Murakamsi
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sayaka Kai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tamaki Yahata
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Akiko Kanto
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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Trageser N, Sauerwald A, Ludwig S, Malter W, Wegmann K, Karapanos L, Radosa J, Jansen AK, Eichler C. A biomechanical analysis of different meshes for reconstructions of the pelvic floor in the porcine model. Arch Gynecol Obstet 2021; 305:641-649. [PMID: 34845538 PMCID: PMC8918124 DOI: 10.1007/s00404-021-06344-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022]
Abstract
Purpose Many different surgical approaches have been established for the repair of a pelvic organ prolapse. Especially in laparoscopic surgery, it is important to generate easy surgical techniques with similar stability. This study shall simplify the choice of mesh by evaluating three polypropylene meshes regarding their biomechanical properties. Methods Biomechanical testing was performed in the porcine model. The meshes are fixated on porcine fresh cadaver cervices after subtotal hysterectomy. The apical part of the mesh is fixated with parallel screw clamps at the testing frame. Forty-one trials were performed overall, subdivided into four subgroups. The groups differ in mesh type and fixation method. Maximum load, displacement at failure and stiffness parameters were evaluated with an Instron 5565® test frame. Results SERATEX® E11 PA (E11) showed the highest values for maximum load (199 ± 29N), failure displacement (71 ± 12 mm) and stiffness (3.93 ± 0.59 N/mm). There was no significant difference in all three evaluated parameters between SERATEX® B3 PA (B3) and SERATEX® SlimSling® with bilateral fixation (SSB). SERATEX® SlimSling® with unilateral fixation (SSU) had the lowest stiffness (0.91 ± 0.19 N/mm) and maximum load (30 ± 2 N) but no significant difference in displacement at failure. Conclusion All meshes achieved a good tensile strength, but the results of maximum load show that the E11 is superior to the other meshes. Through a bilateral fixation of SERATEX® SlimSling®, a simple operating method is generated without a loss of stability.
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Chang CL, Chen CH, Yang SSD, Chang SJ. An updated systematic review and network meta-analysis comparing open, laparoscopic and robotic-assisted sacrocolpopexy for managing pelvic organ prolapse. J Robot Surg 2021; 16:1037-1045. [PMID: 34779989 DOI: 10.1007/s11701-021-01329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Abdominal sacrocolpopexy is considered as the gold standard treatment for pelvic organ prolapse. Sacrocolpopexy can be performed using open (OSC), laparoscopic (LSC), and robotic-assisted (RSC) approaches. The aim of this study is to compare the outcomes between these three approaches for managing pelvic organ prolapse by conducting a systematic review and network meta-analysis. A systematic search was performed in different databases from their earliest records to April 2021 with no restriction on languages. Only randomized controlled trials that compared the outcomes between OSC, LSC, and RSC were included in this study. A total of 6 studies with 486 participants were included in this study. Operative time was significantly shorter in OSC than in RSC and LSC. The probability rank showed less estimated blood loss in RSC and lowest overall postoperative complications in LSC. Probability scores also showed best anatomical outcomes for postoperative points C and Bp in RSC and for point Ba in LSC. Despite significantly longer operative time, RSC and LSC may provide better anatomical outcomes, less estimated blood loss, and less overall postoperative complications than OSC. However, this study did not find significant differences between RSC and LSC in efficacy and safety.
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Affiliation(s)
- Chia-Lun Chang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan
| | - Chun-Hua Chen
- Department of Neurology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan. .,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan.
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Nam G, Lee SR, Roh AM, Kim JH, Choi S, Kim SH, Chae HD. Single-Incision vs. Multiport Robotic Sacrocolpopexy: 126 Consecutive Cases at a Single Institution. J Clin Med 2021; 10:jcm10194457. [PMID: 34640475 PMCID: PMC8509716 DOI: 10.3390/jcm10194457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Robot-assisted laparoscopic sacrocolpopexy (RSC) has gained popularity as a method for easier intracorporeal suturing than conventional laparoscopic sacrocolpopexy. However, few studies have compared multiport RSC (MP-RSC) and single-incision RSC (SI-RSC). We aimed to compare perioperative outcomes between these techniques for advanced pelvic organ prolapse (POP). We analyzed 126 patients who underwent RSC for POP quantification (all stage III to IV) between March 2019 and May 2021 at Seoul Asan Medical Center. We prospectively collected operation-related data, including total operation time (OT; from skin incision to closure) and perioperative outcomes. A total of 106 and 20 patients underwent MP-RSC and SI-RSC, respectively. The mean ages were 57.49 ± 10.89 and 56.20 ± 10.30 years in the MP-RSC and SI-RSC groups, respectively. The mean total OT was significantly shorter for MP-RSC than for SI-RSC (105.43 ± 24.03 vs. 121.10 ± 26.28 min). The OT difference was 15.67 min (95% confidence interval, 3.90-25.85, p = 0.009). No statistically significant differences were observed in terms of perioperative variables (estimated blood loss, hospital stay) and postoperative adverse events (POP recurrence, mesh erosion). SI-RSC had comparable intraoperative and postoperative outcomes to MP-RSC, with additional cosmetic benefits. MP-RSC had significantly shorter OT than SI-RSC.
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Affiliation(s)
- Gina Nam
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Korea;
| | - Sa-Ra Lee
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
| | - A-mi Roh
- Department of Obstetrics and Gynecology, Wonder Women’s Clinic, 1074, Gyeongui-ro, Paju-si 10908, Gyeonggi-do, Korea;
| | - Ju-Hee Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Sungwook Choi
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Sung-Hoon Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Hee-Dong Chae
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
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Surgical Management of Symptomatic Apical Pelvic Organ Prolapse: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 137:1061-1073. [PMID: 33957652 DOI: 10.1097/aog.0000000000004393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP). DATA SOURCES MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English. METHODS OF STUDY SELECTION From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded. TABULATION, INTEGRATION, AND RESULTS Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1-5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22-2.74 and RR 2.70, 95% CI 1.33-5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47-0.75 and RR 0.59, 95% CI 0.44-0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures. CONCLUSION Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1-5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019133869.
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Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy. Female Pelvic Med Reconstr Surg 2021; 27:740-745. [PMID: 34261105 DOI: 10.1097/spv.0000000000001043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate whether an enhanced recovery after surgery (ERAS) protocol was associated with a higher rate of same-day discharge after robot-assisted or laparoscopic sacrocolpopexy and to describe the safety and feasibility of same-day discharge after these procedures. METHODS A historical control, retrospective cohort study of women undergoing minimally invasive sacrocolpopexy comparing rates of same-day discharge before and after implementation of an ERAS protocol was conducted. Secondary outcomes were obtained by comparing women discharged the same day with those discharged postoperative day ≥1, including postoperative complications and unplanned postoperative patient encounters within 30 days of surgery. Logistic regression was performed to control for potential confounders. RESULTS Of the 166 women identified (83 before ERAS implementation; 83 after ERAS implementation), 43 underwent same-day discharge versus 123 admitted overnight. The rate of same-day discharge increased 28 percentage points after ERAS implementation (12% vs 40%, P < 0.01). Compared with women admitted overnight, same-day discharge women had shorter procedures (154 vs 173 minutes, P = 0.01), spent longer time in the postanesthesia care unit (130 vs 106 minutes, P = 0.01), and were more likely to be discharged with a Foley catheter (58% vs 28%, P < 0.01). After multivariable logistic regression analysis, ERAS was associated with increased odds of same-day discharge (odds ratio, 4.91; 95% confidence interval, 2.17-11.09). There were no differences in unplanned postoperative patient contacts or postoperative complications within 30 days between same-day discharge and overnight admission groups. CONCLUSIONS Implementation of an ERAS protocol for minimally invasive sacrocolpopexy was associated with a 3-fold increase in same-day discharge.
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Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis. Int Urogynecol J 2021; 33:3-13. [PMID: 34081163 PMCID: PMC8739324 DOI: 10.1007/s00192-021-04823-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.
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Sanci A, Akpinar C, Gokce MI, Süer E, Gülpinar O. Is robotic-assisted sacrocolpo(hystero)pexy safe and effective in women over 65 years of age? Int Urogynecol J 2021; 32:2211-2217. [PMID: 33587163 DOI: 10.1007/s00192-021-04677-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the safety and efficacy of robotic-assisted sacrocolpo(hystero)pexy in elderly patients with symptomatic apical pelvic organ prolapse and to compare the outcomes of open abdominal and robotic-assisted sacrocolpo(hystero)pexy in geriatric patients. METHODS Elderly patients (≥65 years of age) who underwent open abdominal or robotic-assisted sacrocolpo(hystero)pexy for treatment of symptomatic grade 3 and 4 apical pelvic organ prolapse between November 2015 and May 2019 were evaluated retrospectively. The success rates of the procedures, the surgical outcomes, and the perioperative adverse events of both groups were compared. Perioperative adverse events were categorized according to the Clavien-Dindo classification. RESULTS Forty-four patients underwent open abdominal sacrocolpo(hystero)pexy and 30 patients underwent robotic-assisted sacrocolpo(hystero)pexy. The mean age in the open abdominal sacrocolpo(hystero)pexy group was 68.4 ± 3.4 years and in the robotic-assisted sacrocolpo(hystero)pexy group it was 69.7 ± 4.1 years. The success rates in the open abdominal sacrocolpo(hystero)pexy and robotic-assisted sacrocolpo(hystero)pexy groups were 59% and 57% at median follow-up time of 28 months and 24 months respectively. Although the mean dosage of the analgesic (10.1 mg/24 h) and the mean length of hospital stay (2.1 days) were significantly lower and shorter for the robotic-assisted sacrocolpopexy group, the mean duration of operation was considerably longer (141.2 min). The rate of grade 2 or higher complications for open abdominal sacrocolpopexy was 16% (7 out of 44) and for robotic-assisted sacrocolpopexy it was 17% (5 out of 30). CONCLUSIONS Anatomical outcomes and adverse events are similar in elderly patients undergoing open sacrocolpo(hystero)pexy and robotic-assisted sacrocolpo(hystero)pexy.
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Affiliation(s)
- Adem Sanci
- Urology Department, Ankara University Faculty of Medicine, Adnan Saygun Caddesi, Altindag, 06480, Ankara, Turkey.
| | - Cagri Akpinar
- Urology Department, Cubuk Halil Sivgin State Hospital, Ankara, Turkey
| | - Mehmet Ilker Gokce
- Urology Department, Ankara University Faculty of Medicine, Adnan Saygun Caddesi, Altindag, 06480, Ankara, Turkey
| | - Evren Süer
- Urology Department, Ankara University Faculty of Medicine, Adnan Saygun Caddesi, Altindag, 06480, Ankara, Turkey
| | - Omer Gülpinar
- Urology Department, Ankara University Faculty of Medicine, Adnan Saygun Caddesi, Altindag, 06480, Ankara, Turkey
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Geoffrion R, Larouche M. Directive clinique n o 413 : Traitement chirurgical du prolapsus génital apical chez les femmes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:524-538.e1. [PMID: 33548502 DOI: 10.1016/j.jogc.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIF Comparer les taux de réussite et de complications des interventions de suspension apicale pour le traitement du prolapsus symptomatique de l'utérus ou du dôme vaginal. POPULATION CIBLE Les femmes présentant un prolapsus symptomatique de l'utérus ou du dôme vaginal qui souhaitent obtenir un traitement chirurgical. OPTIONS Les interventions abordées sont les méthodes reconstructives apicales par voie abdominale (colposacropexie, hystérosacropexie ou hystéropexie avec suspension aux ligaments utéro-sacrés) par chirurgie ouverte, laparoscopique ou robotisée; les méthodes reconstructives apicales par voie vaginale (suspension du dôme vaginal ou hystéropexie, sacrospinofixation, suspension aux ligaments utéro-sacrés, suspension au muscle ilio-coccygien, culdoplastie de McCall ou amputation du col [technique de Manchester]); et les interventions vaginales oblitérantes (avec ou sans utérus in situ). Les interventions individuelles ou les grandes catégories d'interventions ont été comparées : (1) reconstruction par voie vaginale versus abdominale, (2) interventions reconstructives par voie abdominale, (3) interventions reconstructives par voie vaginale, (4) reconstruction par hystérectomie avec suspension par comparaison à la reconstruction par hystéropexie et (5) options reconstructives versus oblitérantes. RéSULTATS: Le comité d'urogynécologie a sélectionné les résultats cliniques suivants : échec objectif (obtenu par des systèmes validés de quantification du prolapsus génital et défini comme un échec global objectif et un taux d'échec par compartiment); échec subjectif (réapparition de la sensation de protubérance déterminée subjectivement, avec ou sans l'utilisation d'un questionnaire validé); réopération pour un prolapsus génital récidivé; complications postopératoires de troubles mictionnels (incontinence urinaire d'effort de novo ou postopératoire; réopération d'une incontinence urinaire d'effort de novo, persistante ou récidivée; incontinence urinaire par urgenturie; et dysfonction mictionnelle); lésion des voies urinaires détectée en périopératoire (vessie ou uretère); autres complications (exposition prothétique, définie comme un treillis visible et exposé dans le vagin et une douleur pelvienne non sexuelle); et fonction sexuelle (dyspareunie de novo et score de la fonction sexuelle d'après un questionnaire validé). BéNéFICES, RISQUES ET COûTS: Cette directive clinique sera bénéfique pour les patientes qui souhaitent obtenir une correction chirurgicale du prolapsus génital apical en améliorant les conseils sur les options de traitement chirurgical et les résultats cliniques possibles. La directive sera également utile pour les fournisseurs de soins chirurgicaux en améliorant leurs connaissances sur diverses méthodes chirurgicales. Les données présentées pourraient servir à élaborer des cadres et des outils pour la prise de décision partagée. DONNéES PROBANTES: Nous avons effectué des recherches dans les bases de données Medline, Cochrane Central Register of Controlled Trials (CENTRAL) et Embase pour des articles publiés entre 2002 et 2019. Les termes de recherche étaient nombreux et portaient sur les interventions de correction du prolapsus génital apical, les voies d'abord et les complications. Nous avons exclu les reconstructions par treillis transvaginal et les études comparant les interventions sans suspension apicale. Nous avons inclus des essais cliniques randomisés et des études comparatives prospectives ou rétrospectives. Nous avons limité nos recherches aux articles publiés en anglais ou en français dont le texte intégral était accessible. Une revue systématique des articles avec méta-analyse a ensuite été effectuée. MéTHODES DE VALIDATION: Les auteures ont évalué la qualité des données probantes et la force des recommandations en utilisant lecadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CIBLES Gynécologues, urologues, urogynécologues et autres fournisseurs de soins de santé qui évaluent, conseillent et soignent des femmes ayant un prolapsus génital. DÉCLARATIONS SOMMAIRES: Toutes les déclarations font référence à la correction du prolapsus génital apical à court et à moyen terme (jusqu'à 5 ans), sauf indication contraire. RECOMMANDATIONS.
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Geoffrion R, Larouche M. Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:511-523.e1. [PMID: 33548503 DOI: 10.1016/j.jogc.2021.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. TARGET POPULATION Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. OPTIONS Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. OUTCOMES The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). BENEFITS, HARMS, AND COSTS This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. EVIDENCE We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED USERS Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. SUMMARY STATEMENTS All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified. RECOMMENDATIONS
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Shekhar S, Goyal S, Goel M, Sharma C, Jhirwal M. Medium-Term Anatomical and Functional Results of Isolated Laparoscopic Sacrocolpopexy for Female Pelvic Organ Prolapse during the Early Learning Curve. J Obstet Gynaecol India 2021; 71:91-94. [PMID: 33814807 PMCID: PMC7960832 DOI: 10.1007/s13224-020-01373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Laparoscopic repair of female pelvic organ prolapse is a technically challenging surgery, especially for the beginners. METHODS We performed a follow-up study of women who underwent laparoscopic sacrocolpopexy or sacrohysteropexy (LSCP/LSHP) for pelvic organ prolapse between January 2015 and October 2019. We analysed anatomical and subjective success rates, peri-operative complications and medium-term complications. RESULTS Twenty women underwent LSCP/LSHP with average follow-up of 16 months. Anatomical success rate was 95%, and subjective success rate was 90%. Blood loss averaged at 24 ml. Majority of women (90%) reported improvement in their symptoms and 10% reported no change in symptoms. There were no mesh complications. CONCLUSION Laparoscopic sacrocolpopexy is an effective and safe surgery for female pelvic organ prolapse even by beginners.
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Affiliation(s)
- Shashank Shekhar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Shuchita Goyal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Manu Goel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Charu Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
| | - Manisha Jhirwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Jodhpur, 501/6, Residential Complex, Jodhpur, Rajasthan India
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Aubert M, Mege D, Le Huu Nho R, Meurette G, Sielezneff I. Surgical management of the rectocele - An update. J Visc Surg 2021; 158:145-157. [PMID: 33495108 DOI: 10.1016/j.jviscsurg.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rectocele is defined as a hernia of the rectum with protrusion of the anterior rectal wall through the posterior wall of the vagina. This condition occurs commonly, with an estimated prevalence of 30-50% of women over age 50. The symptomatology that leads to consultation is variable but consists predominantly of anorectal and/or gynecological complaints such as dyschezia, requiring digital disimpaction maneuvers, pelvic heaviness, anal incontinence, or dyspareunia. Rectocele may be isolated or associated with other disorders of pelvic stasis involving cystocele and uterine prolapse. Complementary exams (dynamic imaging and anorectal manometry) are essential before deciding on the surgical management of this condition. The indications for surgical management of rectocele are based on the intensity of symptoms and the resulting deterioration in quality of life, and surgery should be discussed after failure of medical treatment. Different approaches are possible, although there is currently no real consensus in the literature. The initial approach depends on the type of rectocele: if it involves the low or mid rectum or is isolated, an approach from below (transanal, transperineal, or transvaginal approach) can be proposed, while, in the presence of a high rectocele and/or associated with various disorders of pelvic stasis, transabdominal rectopexy is more suitable.
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Affiliation(s)
- M Aubert
- Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France
| | - D Mege
- Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France.
| | - R Le Huu Nho
- Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France
| | - G Meurette
- Department of cancer, digestive and endocrine surgery, Nantes university hospital, 44093 Nantes, France
| | - I Sielezneff
- Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France
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De Smet J, Page A, Deprest J, Housmans S, Niu K, Vander Poorten E. A uniaxial force and stiffness model of the vagina during laparoscopic sacrocolpopexy. Clin Biomech (Bristol, Avon) 2021; 81:105204. [PMID: 33189455 DOI: 10.1016/j.clinbiomech.2020.105204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/03/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic sacrocolpopexy is the preferred procedure for restoring vaginal vault prolapse. An assistant uses a vaginal manipulator to position and tension the vault such that the surgeon can dissect the bladder, rectum and vault to eventually suture a synthetic mesh used to suspend the vagina to the longitudinal anterior vertebral ligament. Vaginal vault manipulation requires application of high forces for long periods of time. METHODS This work quantifies the task by measuring and analyzing the interaction forces and the workspace during vaginal vault manipulation. From the measurements we developed a uniaxial model, expressing the increase in interaction force and stiffness of the vagina. By adapting the model parameters, the difference in interaction force and stiffness between moderate and severe prolapse is predicted. FINDINGS For moderate prolapse the average interaction force and stiffness start at 2.56 N and 0.11 N mm-1 in the tensionfree state, and go up to 20.14 N and 0.53 N mm-1 after complete insertion of the instrument. For severe degrees of prolapse, tissue interaction is much lower starting at 1.68 N and 0.06 N mm-1 while staying limited to 12.20 N and 0.30 N mm-1 at full extension. INTERPRETATION Population data shows that the stage of prolapse and total vaginal length increase with age and parity. The interaction force and stiffness of the vagina are correlated with this degree of prolapse. By adapting the model parameters a good estimation of the tissue interaction is found for patients with mild and severe prolapse.
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Affiliation(s)
- J De Smet
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium.
| | - A Page
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium
| | - J Deprest
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Cluster Urogenital, Abdominal and Plastic Surgery, Herestraat 49, Leuven, Belgium
| | - S Housmans
- UZ Leuven, Department of Obstetrics and Gynaecology, Herestraat 49, Leuven, Belgium
| | - K Niu
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium
| | - E Vander Poorten
- KU Leuven, Department of Mechanical Engineering, Celestijnenlaan 300, Leuven, Belgium
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Ajao MO, Gu X, Kohli N, Einarsson JI. Peri- and Postoperative Outcomes of Outpatient vs Inpatient Laparoscopic Apical Prolapse Repair. J Minim Invasive Gynecol 2020; 28:1508-1513. [PMID: 33310166 DOI: 10.1016/j.jmig.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To assess the feasibility of outpatient laparoscopic management of apical pelvic organ prolapse along with indicated vaginal repairs and anti-incontinence procedures. DESIGN Retrospective cohort study. SETTING Tertiary-care academic center, Boston, MA. PATIENTS Total of 112 patients seen in the minimally invasive gynecologic surgery and urogynecology clinics with symptomatic pelvic organ prolapse. INTERVENTIONS Laparoscopic hysterectomy, sacrocervico- or sacrocolpopexy along with vaginal prolapse and anti-incontinence procedures as indicated from 2013 to 2017 at Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital performed by a minimally invasive gynecologic surgery and urogynecology team. MEASUREMENTS AND MAIN RESULTS Of the 112 patients, 52 were outpatient and 60 were admitted (median stay in admission group = 1 day; range 1-3). Patient baseline characteristics, American Society of Anesthesiologists' class, and pelvic organ prolapse quantification stage were similar between the outpatient and admitted cohorts. Most patients underwent hysterectomy at the time of the sacropexy (65.4% outpatient vs 73.3% admitted, p = .08). Concomitant apical prolapse repair was more common in the outpatient group (98.1% vs 85%, p = .02). The proportion of outpatient procedures increased from 17% in 2013 to a peak of 70% in 2016. Operating room time was shorter for the outpatient cohort (103.9 minutes vs 115.5 minutes, p = .04), but other perioperative outcomes were similar. There were no intraoperative complications. The numbers of postoperative complications, readmission, and reoperations were low and similar between outpatient and admitted cohorts. No factor was predictive of admission on regression analysis. CONCLUSION Laparoscopic apical prolapse repair with concomitant vaginal repairs can be performed safely as an outpatient procedure. A unique team approach may foster a shorter, more efficient procedure without compromising short-term outcomes.
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Affiliation(s)
- Mobolaji O Ajao
- Division of Minimally Invasive Gynecologic Surgery, Brigham & Women's Hospital (Drs. Ajao, Einarsson, and Ms. Gu), Boston, Massachusetts; Boston Urogynecology (Dr. Kohli), Boston Massachusetts, Wellesley, Massachusetts.
| | - Xiangmei Gu
- Division of Minimally Invasive Gynecologic Surgery, Brigham & Women's Hospital (Drs. Ajao, Einarsson, and Ms. Gu), Boston, Massachusetts; Boston Urogynecology (Dr. Kohli), Boston Massachusetts, Wellesley, Massachusetts
| | - Neeraj Kohli
- Division of Minimally Invasive Gynecologic Surgery, Brigham & Women's Hospital (Drs. Ajao, Einarsson, and Ms. Gu), Boston, Massachusetts; Boston Urogynecology (Dr. Kohli), Boston Massachusetts, Wellesley, Massachusetts
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Brigham & Women's Hospital (Drs. Ajao, Einarsson, and Ms. Gu), Boston, Massachusetts; Boston Urogynecology (Dr. Kohli), Boston Massachusetts, Wellesley, Massachusetts
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Aydın S, Ateş S, Gökmen Karasu AF, Arıoğlu Ç. Short and middle-term outcomes of vaginally assisted laparoscopic sacropolpopexy. Low Urin Tract Symptoms 2020; 13:291-298. [PMID: 33289346 DOI: 10.1111/luts.12369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Vaginally assisted laparoscopic sacrocolpopexy (VALS), which is a combined surgical approach where a vaginal hysterectomy is initially performed, followed by transvaginal placement of synthetic mesh and laparoscopic suspension, can be an alternative to overcome the dissection, suturing limitations of laparoscopic sacrocolpopexy. The aim of this study was to compare the operative times and middle-term anatomic outcomes of women with uterovaginal prolapse undergoing VALS with those of women undergoing abdominal sacrocolpopexy. METHODS This is a prospective cohort study that evaluates operation times, anesthesia times, estimated blood loss, middle-term outcomes, perioperative and postoperative complications. We compared the results of 47 women who had the VALS to that of 32 abdominal sacrocolpopexy (AS). RESULTS The mean follow up was 22.4 months for AS group and 20.5 months for VALS group. The VALS group (median 1 day) had shorter hospitalization duration than the AS group (median 3 days). The mean operation time was significantly shorter in the VALS group (125.9 minutes) than the AS group (151.9 minutes) (P = .03). There was no significant difference in perioperative and postoperative complication rates. Objective failure rate (8.5% in VALS, 15.6% in AS), subjective failure rates (6.4% in VALS, 9.4% in AS), recurrence (2.1% in VALS, 9.4% in AS) and mesh exposition rates (2.1% in VALS, 9.4% in AS) were similar in both procedures. CONCLUSIONS VALS with shorter operative time and hospitalization than conventional AS is a promising modification minimally invasive technique for sacrocolpopexy especially for those inexperienced in laparoscopic sacrocolpopexy.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetric and Gynecology İstanbul, Koc University School of Medicine, Istanbul, Turkey
| | - Seda Ateş
- Department of Obstetric and Gynecology İstanbul, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Çağrı Arıoğlu
- Department of Obstetric and Gynecology İstanbul, Medicalpark Hospitals, Istanbul, Turkey
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Capmas P, Suarthana E, Larouche M. Conversion rate of laparoscopic or robotic to open sacrocolpopexy: are there associated factors and complications? Int Urogynecol J 2020; 32:2249-2256. [PMID: 33104825 DOI: 10.1007/s00192-020-04570-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the conversion rate of laparoscopic or robotic to open sacrocolpopexy and to identify associated factors in a large population-based database. METHODS We used Health Care Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) databases 2005-2014. We extracted data on apical suspension and synthetic mesh with laparoscopy or robot in adult women using International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) codes. We evaluated the rate of conversion and used logistic regression to study the association with risk factors. RESULTS We identified 3295 women with laparoscopic or robotic sacrocolpopexies. There were 2777 robotic procedures with 37 conversion (1.33%) and 518 laparoscopic procedures with 37 conversions (7.14%), with an overall conversion rate of 2.2%. Median age was 62 years [interquartile range (IQR) = 55-69]. Concomitant hysterectomy was significantly more frequent in the robotic than laparascopic group (41.7% versus 13.9%, p < 0.01) and was not associated with conversion. Factors associated with lower conversion included a robotic approach (adjusted odd ratio (aOR) 0.32 [95% CI 0.19-0.54]) and private insurance (aOR 0.53 [95% CI 0.32-0.86]). Factors associated with higher conversion were obesity (aOR 3.27 [95% CI 1.72-6.19]) and lysis of adhesions (aOR 3.32 [95% CI 1.89-5.85]). Accidental organ puncture was significantly associated with conversion (14.9% versus 3.8%; p < 0.01). CONCLUSION In this American database, the rate of conversion of laparoscopic or robotic to open sacrocolpopexy was low. The majority (84%) of minimally invasive sacrocolpopexies used a robotic approach, which was associated with a lower risk of conversion. Obesity and lysis of adhesions were associated with a higher risk of conversion.
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Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada. .,Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, and Faculty of Medicine, University Paris Sud, 94276, Le Kremlin Bicêtre, France.
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Maryse Larouche
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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Santis-Moya F, Pineda R, Miranda V. Preoperative ultrasound findings as risk factors of recurrence of pelvic organ prolapse after laparoscopic sacrocolpopexy. Int Urogynecol J 2020; 32:955-960. [PMID: 32852573 DOI: 10.1007/s00192-020-04503-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study is to evaluate levator ani muscle avulsion (LAMA) and ballooning as risk factors for recurrence of pelvic organ prolapse (POP) after laparoscopic sacrocolpopexy (SCP). We hypothesize that these ultrasound findings are associated with a higher risk of POP recurrence. METHODS Retrospective cohort study of patients who underwent laparoscopic SCP between January 2015 and December 2018. Baseline translabial 3D ultrasound of the pelvic floor was performed. Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) were applied. Both univariate and multivariate analyses were carried out. RESULTS One hundred thirty-four patients were included. On ultrasound, 32% of patients had levator ani muscle avulsion, and 36.5% had ballooning. Mean follow-up time was 16 months. There was a 13.4% anatomic recurrence; five of them (3.7%) also had symptomatic recurrence. After multivariate analysis we found that LAMA and ballooning were not significant: OR 0.99 (95% CI 0.098-10.1; p = 0.99) and OR 1.1 (95% CI 0.99-1.2; p = 0.06), respectively. CONCLUSIONS LAMA and ballooning on pelvic floor US are not significant risk factors for anatomic POP recurrence after laparoscopic SCP. Laparoscopic SCP has a 13.4% and 3.4% anatomic and symptomatic recurrence rate, respectively, and the majority of patients reported significant improvement in quality of life.
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Affiliation(s)
- Fernanda Santis-Moya
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile.
| | - Rodrigo Pineda
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile
| | - Victor Miranda
- Obstetrics and Gynecology Department, Pontificia Universidad Católica de Chile, Pedro de Valdivia 150 Dept. 1321 Providencia, Santiago, Chile
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Berger AA, Tan-Kim J, Menefee SA. Anchor vs suture for the attachment of vaginal mesh in a robotic-assisted sacrocolpopexy: a randomized clinical trial. Am J Obstet Gynecol 2020; 223:258.e1-258.e8. [PMID: 32413431 DOI: 10.1016/j.ajog.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vaginal mesh attachment can be one of the most time-consuming components of a minimally invasive sacrocolpopexy. OBJECTIVE To assess the impact on the duration vaginal mesh attachment of using absorbable anchors compared to interrupted sutures for vaginal mesh attachment in robotic-assisted sacrocolpopexy. STUDY DESIGN This was a single-masked, randomized clinical trial of women with pelvic organ prolapse that underwent a robotic-assisted sacrocolpopexy at 2 clinical sites. The participants were randomized to receive either interrupted delayed absorbable anchors or sutures during the vaginal mesh attachment portion of the surgery. The participants completed validated questionnaires at baseline and at 6 weeks, 6 months, and 12 months after the surgery. A certified examiner, masked to the attachment technique that was used, performed a clinical examination using the Pelvic Organ Prolapse Quantification system and also assessed for mesh exposure and the overall appearance of the vaginal walls using a 10-cm visual analog scale at each follow-up visit. The primary outcome was the vaginal mesh attachment time. The categorical variables were compared using chi-square or Fischer's Exact test, whereas the continuous variables were compared using Student's t-test or Mann-Whitney U test where appropriate. An intention-to-treat analysis was performed. RESULTS Fifty-three participants were randomized, 26 to mesh attachment with anchor, 27 to mesh attachment with suture, and 81% (21/26) and 93% (25/27) had 12-month follow up respectively. There were no significant differences between the groups with regard to age (P=.12), body mass index (P=.23), stage of prolapse (P=.97), or other preoperative factors. Mesh attachment interval time was faster in the anchor compared to suturing study arm (12.2±7.8 vs 21.2±5.2 minutes; P<.001), while sacrocolpopexy times (107.6±33.2 vs 109.8±21.2 minutes; P=.774) were not different. The ease of placement for the surgeon based on a visual analog scale (P=.16), the appearance of the mesh attachment (P=.07), and the overall satisfaction with the use of the specific attachment type (P=.65) were similar for the arms. There was no difference in perioperative adverse events rates between arms and by 12 months follow-up there were no sacrocolpopexy mesh, anchor, or suture exposures. There was no difference in outcomes at 12 months including composite failure (10% vs 12%; P=.79), patient global impression of improvement (1.06 vs 1.19; P=.27), or patient pelvic pain (9.81 vs 9.67; P=.56). CONCLUSION In patients undergoing a robotic-assisted sacrocolpopexy, the anchor vaginal mesh attachment technique required significantly less time than suturing. There was no difference between techniques in complications, failure, surgeon, or patient-reported outcomes through 12 months of follow-up. Mesh attachment during sacrocolpopexy can be performed in less time by using the anchor technique, providing surgeons with an alternative surgical technique for this procedure.
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Wallace SL, Syan R, Enemchukwu EA, Mishra K, Sokol ER, Gurland B. Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery. Int Urogynecol J 2020; 31:2101-2108. [DOI: 10.1007/s00192-020-04394-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
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Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse. Int Urogynecol J 2020; 32:871-877. [PMID: 32524157 DOI: 10.1007/s00192-020-04374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Concerns regarding the use of vaginal mesh for prolapse have led to questions about the safety and efficacy of abdominally placed mesh. Mesh procedures for treating apical prolapse have become popular, either a laparoscopic hysteropexy (LSH) for uterine prolapse or a sacrocolpopexy (LSC) for vaginal vault prolapse. Robust long-term safety and efficacy data for these procedures are essential. METHODS All patients who had LSH or LSC since 2010 were invited back for face-to-face review and examination. Case notes were reviewed for surgical morbidities and patients were questioned about short- and long-term complications. The Patient Global Impression of Improvement (PGI-I) scale was used to assess prolapse, bladder and bowel symptoms postoperatively. RESULTS One hundred twelve patients were included in the review, 93 of whom were examined. The median time since surgery was 6 years (range 1-9 years); 2.7% cases had an intraoperative complication, two conversions to laparotomy and one bladder injury. Overall, 17.3% patients sought medical review postoperatively, with 10.7% having problems with their skin incisions. With regard to mesh safety, there was one case of bowel obstruction requiring resection following LSH and two vaginal mesh exposures following LSC; 97% had stage 1 or less apical prolapse at long-term follow-up and 79.6% reported symptoms of prolapse to be 'much better' or 'very much better' on the PGI-I scale. CONCLUSIONS This study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications.
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Jochum F, Host A, Hummel M, Akladios C, Lecointre L, Garbin O. Surgical traps in laparoscopic sacrocolpopexy for vaginal vault prolapse. Int Urogynecol J 2020; 31:2675-2677. [PMID: 32494958 DOI: 10.1007/s00192-020-04341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the possible difficulties encountered in the event of laparoscopic sacrocolpopexy for vaginal vault prolapse and corresponding avoidance strategies. METHODS Video recordings of different laparoscopic sacrocolpopexies for vaginal vault prolapse showing various situations and difficulties. University Teaching Hospital of Strasbourg. RESULTS Although laparoscopic sacrocolpopexy for vaginal vault prolapse is becoming more common, achieving a good outcome remains challenging, especially with the vesicovaginal dissection. Bladder injuries are not rare and occur in about 2 to 6% of cases. Vaginal perforation is less common, but remains a risk. This video illustrates possible difficulties encountered and presents various strategies to avoid them. Several tips on exposing structures and following anatomical landmarks are described. CONCLUSION Knowing how to avoid these surgical traps will help trainee urogynecologic surgeons to perform laparoscopic sacrocolpopexy for vaginal vault prolapse.
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Affiliation(s)
- Floriane Jochum
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France.
| | - Aline Host
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Michel Hummel
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Garbin
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
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Nemirovsky A, Herbert AS, Gorman EF, Malik RD. A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy. Neurourol Urodyn 2020; 39:1264-1275. [PMID: 32469449 DOI: 10.1002/nau.24411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/14/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) pathways have been shown to reduce surgical morbidity and length of stay across various procedures. Our objective was to systematically evaluate the literature for best practices of ERAS elements in abdominal sacrocolpopexy (ASC), to determine if there is sufficient evidence to create best practice guidelines for this procedure. MATERIALS AND METHODS Following the preferred reporting items for systematic review and meta-analysis (PRISMA) statement, we performed a review using Pubmed, Embase, and Cochrane Library. Eligible articles contained ERAS components and postoperative outcomes of ASC published in English since 1997. Thirty-five full-text articles were selected for final qualitative analysis. RESULTS Poor functional status before ASC was associated with a longer length of hospital stay. Laparoscopic ASC was associated with a shorter postoperative hospital stay, with no difference between laparoscopic and robotic approaches. Epidural analgesia in addition to spinal anesthesia lowered levels of pain throughout the postoperative stay in laparoscopic ASC. A multimodal bowel regimen shortened time to first bowel movement compared to a single agent regimen. Removing a Foley catheter may lead to sooner first spontaneous void but may result in higher rates of urinary retention and urinary tract infection. Studies investigating preoperative bowel preparation, preanesthesia medication, and multidose antimicrobial prophylaxis did not show significant benefit. CONCLUSIONS Best practices for ASC can be developed based on current findings from the literature and extrapolation of evidence from other surgeries where ASC-specific elements are missing, with the ability to modify the pathways as new data become available.
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Affiliation(s)
- Amy Nemirovsky
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Amber S Herbert
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland
| | - Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
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Campagna G, Panico G, Caramazza D, Anchora LP, Parello A, Gallucci V, Vacca L, Scambia G, Ercoli A, Ratto C. Laparoscopic sacrocolpopexy plus ventral rectopexy as combined treatment for multicompartment pelvic organ prolapse. Tech Coloproctol 2020; 24:573-584. [DOI: 10.1007/s10151-020-02199-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/29/2020] [Indexed: 01/05/2023]
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