1
|
Winget VL, Gabra MG, Addis IB, Hatch KK, Heusinkveld JM. Laparoscopic pectopexy for patients with intraabdominal adhesions, lumbar spinal procedures, and other contraindications to sacrocolpopexy: a case series. AJOG GLOBAL REPORTS 2022; 2:100034. [PMID: 36275496 PMCID: PMC9563903 DOI: 10.1016/j.xagr.2021.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Laparoscopic pectopexy is an alternative to sacrocolpopexy utilizing fixation points in the anterior pelvis for vaginal vault suspension; it was originally developed for an obese population. This is a retrospective case series of 7 women who underwent laparoscopic pectopexy at one academic Institution between October 2019 and December 2020. The patients had preoperative vaginal vault prolapse (pelvic organ prolapse quantification system [POP-Q], stage 2 and 3). Pectopexy was performed because of relative contraindications to sacrocolpopexy, including use of antiplatelet therapy, extensive adhesions, and chronic back pain with lumbo-spinal fusion. No intraoperative complications were documented in this cohort. Average blood loss was 32.9 mL. All the patients were discharged home within 24 hours. One patient experienced urinary retention that required release of the retropubic midurethral sling placed at the time of pectopexy. The most recent follow-up examination occurred at an average of 127 days after the procedure. All 7 patients had a resolution of their prolapse (POP-Q ≤1). This case series highlights the application of pectopexy for patients with extensive adhesions, use of antiplatelet therapy and lumbar or sacral spinal surgical history. The complication rates and operative results are comparable with sacrocolpopexy at intermediate-term follow-up in this small case series, indicating that pectopexy may be a promising alternative for patients with relative contraindications to sacrocolpopexy. This is the first report of the application of the technique in North America.
Collapse
|
2
|
Osterhoff G, Reise R, Riemer E, Höch A, Fakler JKM, Heyde CE, Schleifenbaum S. The pectineal ligament is a secondary stabilizer in anterior pelvic ring fractures - a biomechanical study. Injury 2022; 53:334-338. [PMID: 34920874 DOI: 10.1016/j.injury.2021.12.006] [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: 09/03/2020] [Revised: 09/27/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is ongoing discussion whether operative fixation of partially stable lateral compression fractures of the pelvis is beneficial for the patient. Recent studies suggest that the pectineal ligament may act as a secondary stabilizer of the anterior pelvis ring. The purpose of this study was to investigate the influence of the pectineal ligament's integrity on the biomechanical stability and displacement in anterior pelvic ring fractures. METHODS In a biomechanical setup, a cyclic loading protocol was applied with sinusoidal axial force from 100 to 500 N on cadaver hemipelves with soft tissues (n = 5). After testing the native specimens ("No fracture"), increasing degrees of injury were created on the samples: 1. an osseous defect to the pubic ramus ("Bone #"), 2. cutting of all soft tissues including obturator membrane except for the pectineal ligament intact ("ObtM #"), 3. cutting of the pectineal ligament ("PectL #") - with the loading protocol being applied to each sample at each state of injury. Fracture motion and vertical displacement were measured using a digital image correlation system and opto-metric analysis. RESULTS No failure of the constructs was observed. Creating a pubic ramus fracture (p = 0.042) and cutting the pectineal ligament (p = 0.042) each significantly increased relative fracture movement. The mean change in absolute movement was 0.067 mm (range, 0.02 mm to 0.19 mm) for ObtM # and 0.648 mm (range, 0.07 mm to 2.93 mm), for PectL # in relation to Bone # (p = 0.043). Also for absolute vertical movement, there was a significant change when the pectineal ligament was cut (p = 0.043), while there was no such effect with cutting all other soft tissues including the obturator membrane. CONCLUSIONS Based on the findings of this in vitro study, the pectineal ligament significantly contributes to the stability of the anterior pelvic ring. An intact pectineal ligament reduces fracture movement in presence of a pubic ramus fracture.
Collapse
Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Rebekka Reise
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Elena Riemer
- Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes K M Fakler
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany; Centre for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| |
Collapse
|
3
|
Chuang FC, Chou YM, Wu LY, Yang TH, Chen WH, Huang KH. Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy. Int Urogynecol J 2021; 33:1949-1956. [PMID: 34406417 PMCID: PMC9270277 DOI: 10.1007/s00192-021-04934-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse. Conclusions Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.
Collapse
Affiliation(s)
- Fei Chi Chuang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - Yu Min Chou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - Ling Ying Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - Tsai Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - Wen Hsin Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan
| | - Kuan Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan.
| |
Collapse
|
4
|
Karslı A, Karslı O, Kale A. Laparoscopic Pectopexy: An Effective Procedure for Pelvic Organ Prolapse with an Evident Improvement on Quality of Life. Prague Med Rep 2021; 122:25-33. [PMID: 33646939 DOI: 10.14712/23362936.2021.3] [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: 10/22/2022] Open
Abstract
It has been stated that the effectiveness of pectopexy method for the treatment of pelvic organ prolapse (POP) is similar to sacrocolpopexy. We aimed to search the effects of pectopexy method to the quality of life, sexual function and urinary incontinence. Thirty-one patients who were operated for POP with the technique of laparoscopic pectouteropexy/pectocolpopexy between January 2016 and November 2017 were included the study. Exclusion criteria were pelvic inflammatory disease, suspect of malignancy, pregnancy, prior POP or continence surgery. Quality of life inventories were (P-QOL, PISQ-12, UDI-6, IIQ-7) recorded preoperatively and at the postoperative third month. Results were compared statistically. The percentage of patients with menopause was 67.7% (n=21) and with reproductive term was 32.3% (n=10). Mean prolapse related quality of life inventory (P-QOL) score was 83.45 ± 8.7 (64-98) preoperatively and 8.61 ± 6.4 (0-23) postoperatively (p<0.05). The preoperative and postoperative score of quality of life inventories for urinary symptoms were 20 (15-21) and 2 (0-9) for IIQ-7 and 13 (3-18) and 4 (0-11) for UDI-6, respectively (p<0.05). The mean PISQ-12 sexual quality of life inventory score was 29.61 ± 4.8 (14-38) preoperatively and 7.1 ± 3.2 (1-13) postoperatively. According to our results laparoscopic pectopexy offers a feasible, safe and comfortable alternative for apical prolapse surgery.
Collapse
Affiliation(s)
- Aybike Karslı
- Health Science University, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Onur Karslı
- Health Science University, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
| | - Ahmet Kale
- Health Science University, Kartal Dr. Lütfi Kırdar Education and Research Hospital, Kartal, Turkey
| |
Collapse
|
5
|
Klengel A, Steinke H, Pieroh P, Höch A, Denecke T, Josten C, Osterhoff G. Integrity of the pectineal ligament in MRI correlates with radiographic superior pubic ramus fracture displacement. Acta Radiol 2021; 62:67-72. [PMID: 32345026 DOI: 10.1177/0284185120913002] [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: 11/15/2022]
Abstract
BACKGROUND Estimating the stability of pelvic lateral compression fractures solely by static radiographs can be difficult. In this context, the role of anterior pelvic soft tissues as potential secondary stabilizer of the pelvic ring has hardly been investigated. PURPOSE To correlate the initial radiographic appearance of the pubic ramus fracture with the integrity of the pectineal ligament, a strong ligament along the pecten pubis. MATERIAL AND METHODS In total, 31 patients with a pelvic lateral compression fracture (AO/OTA 61- B1.1/B2.1) with 33 superior pubic ramus fractures and available post-traumatic radiographs (pelvis anteroposterior, inlet, outlet) and magnetic resonance imaging (MRI) of the pelvis with fat-suppressed coronal images were reviewed retrospectively. Radiographic superior pubic ramus fracture displacement was measured and correlated to the degree of MR-morphologic alterations of the pectineal ligament (grade 0 = intact, grade 3 = rupture). RESULTS In the majority of fractures (72.7%), associated MR-morphologic alterations of the pectineal ligament were present. Radiographic displacement and MRI grading showed a strong positive correlation (Spearman rho = 0.783, P < 0.001). The sensitivity and specificity for a radiographic displacement of >3 mm on plain radiographs to detect a structural ligament lesion on MRI (grade 2 and higher) were 73% and 100%, respectively. CONCLUSION Radiographic displacement of superior pubic ramus fractures >3 mm is a strong indicator for a structural lesion of the pectineal ligament. Future studies should investigate the potential biomechanical importance of this ligament for pelvic ring stability.
Collapse
Affiliation(s)
- Alexis Klengel
- Department of Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Hanno Steinke
- Institute of Anatomy, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Philipp Pieroh
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Timm Denecke
- Department of Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
6
|
Pulatoğlu Ç, Doğan O, Medisoğlu MS, Yassa M, Ellibeş Kaya A, Selçuk İ, Bayık RN. Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures. Turk J Obstet Gynecol 2020; 17:21-27. [PMID: 32341826 PMCID: PMC7171544 DOI: 10.4274/tjod.galenos.2020.21284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to the right obturator canal it was 3.57±0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.
Collapse
Affiliation(s)
- Çiğdem Pulatoğlu
- İstinye University Hospital Gaziosmanpaşa Medical Park, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ozan Doğan
- Private Clinic, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | | | - Murat Yassa
- Sancaktepe Şehit Professor İlhan Varank Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Aşkı Ellibeş Kaya
- Düzce University Hospital, Clinic of Obstetrics and Gynecology, Düzce, Turkey
| | - İlker Selçuk
- University of Health Sciences Turkey, Ankara Bilkent City Hospital, Clinic of Gynecologic Oncology/Hacettepe University Faculty of Medicine, Department of Anatomy, Ankara, Turkey
| | - Rahime Nida Bayık
- University of Health Sciences Turkey, Göztepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|
7
|
Steinke H, Wiersbicki D, Völker A, Pieroh P, Kulow C, Wolf B, Osterhoff G. The fascial connections of the pectineal ligament. Clin Anat 2019; 32:961-969. [PMID: 31381189 DOI: 10.1002/ca.23445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
In clinical settings, the pectineal ligament forms a basic landmark for surgical approaches. However, to date, the detailed fascial topography of this ligament is not well understood. The aim of this study was to describe the morphology of the pectineal ligament including its fascial connections to surrounding structures. The spatial-topographical relations of 10 fresh and embalmed specimens were dissected, stained, slice plastinated, and analyzed macroscopically, and in three cases histological approaches were also used. The pectineal ligament is attached ventrally and superiorly to the pectineus muscle, connected to the inguinal ligament by the lacunar ligament and to the tendinous origin of rectus abdominis muscle and the iliopubic tract. It forms a site of origin for the internal obturator muscle, and throughout its curved course, the ligament attaches to both the fasciae of iliopsoas and the internal obturator muscle. However, dorsally, these fasciae pass free from the bone, while the pectineal ligament itself is adhered to it. The organ fasciae are seen apart from the pectineal ligament and its connections. The pectineal ligament seems to form a connective tissue junction between the anterior and medial compartment of the thigh. This ligament, however, is free to other compartments arisen from the embryonal gut and to the urogenital ridge. These features of the pectineal ligament are important to consider during orthopedic and trauma surgical approaches, in gynecology, hernia and incontinence surgery, and in operations for pelvic floor and neovaginal reconstructions. Clin. Anat. 32:961-969, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Hanno Steinke
- Institute of Anatomy, Leipzig University, Leipzig, Germany
| | | | - Anna Völker
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| | - Philipp Pieroh
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| | | | - Benjamin Wolf
- Department for Gynecology, University Hospital Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Orthopedics, Trauma Surgery and Plastic Surgery, Spine Center, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
8
|
Kale A, Biler A, Terzi H, Usta T, Kale E. Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery. Int Braz J Urol 2017; 43:903-909. [PMID: 28727377 PMCID: PMC5678522 DOI: 10.1590/s1677-5538.ibju.2017.0070] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/26/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. MATERIALS AND METHODS Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. RESULTS The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. CONCLUSION Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.
Collapse
Affiliation(s)
- Ahmet Kale
- Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Alper Biler
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Taner Usta
- Department of Obstetrics and Gynecology, Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Ebru Kale
- Department of Biochemistry, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| |
Collapse
|
9
|
Faure JP, Doucet C, Rigouard P, Richer JP, Scépi M. Anatomical pitfalls in the technique for total extra peritoneal laparoscopic repair for inguinal hernias. Surg Radiol Anat 2006; 28:486-93. [PMID: 17021947 DOI: 10.1007/s00276-006-0143-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 05/31/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE The totally extraperitoneal laparoscopic approach for the treatment of inguinal hernia is a well-recognized technique with proven efficacy, low failure rate, and reduced post-operative pain. This laparoscopic technique is reputed to be a more difficult procedure to learn and practice than a laparoscopic trans-abdomino-pre-peritoneal procedure: we hope this is because many surgeons don't well know extra-peritoneal anatomy of groin. So we proposed a "step by step" anatomical analysis, with pitfalls to avoid, of a totally extraperitoneal laparoscopic approach for treatment of inguinal hernia. METHODS Our experience with totally extraperitoneal laparoscopic inguinal hernia repair with regard to the morphology of the inguinal-femoral region concerns 23 cadaver dissection and more than 400 surgical procedures, now permits clarification of a surgical technique that has hitherto not been well known. CONCLUSION Photographic representations of surgical views are displayed, and detailed descriptions applicable to anatomical structures are presented.
Collapse
Affiliation(s)
- J P Faure
- Service Chirurgie Viscérale Digestive et Endocrinienne, Hôpital Jean Bernard, CHU Poitiers, rue de la Miletrie, BP 577, 86021, Poitiers cedex, France.
| | | | | | | | | |
Collapse
|