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Pecorella G, Sparic R, Morciano A, Babovic I, Panese G, Tinelli A. Fortifying the foundation: assessing the role of uterine ligament integrity in uterine prolapse and beyond. Arch Gynecol Obstet 2024; 310:2333-2343. [PMID: 39302411 DOI: 10.1007/s00404-024-07732-7] [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: 06/14/2024] [Accepted: 09/06/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions. OBJECTIVE To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes. METHODS This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation. RESULTS - The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs. - Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders. - Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse. - Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches. CONCLUSION This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Kirrbergerstraße 100, Building 9, 66424, Homburg, Germany.
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Andrea Morciano
- Department of Obstetrics and Gynaecology, Pia Fondazione Cardinale G. Panico, 73039, Tricase, Italy
| | - Ivana Babovic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL, (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, Scorrano, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL, (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, Scorrano, Lecce, Italy
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Cianci S, Ronsini C, Riemma G, Palmara V, Romeo P, La Verde M, Laganà AS, Capozzi V, Andreoli G, Palumbo M, Torella M. Multicentric data analysis of the learning curve for laparoscopic Shull's repair of pelvic floor defects. Front Surg 2024; 11:1396438. [PMID: 38948480 PMCID: PMC11212461 DOI: 10.3389/fsurg.2024.1396438] [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: 03/05/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Pelvic organs prolapse remains a significant health concern affecting millions of women worldwide. The use of native tissues to suspend the apex has acquired relevance in urogynecologic surgery. One of the most commonly used procedures performed without mesh is the technique described by Shull, consisting of suturing the vaginal apex to the uterosacral ligaments. The objective of the study is to evaluate the learning curve of laparoscopic Shull's repair for the correction of pelvic floor defects, including the surgery time and surgical outcomes. Materials and methods This is a retrospective study conducted at the Policlinico G. Martino, University of Messina, Messina, Italy, and Policlinico Vanvitelli, Vanvitelli University, Naples, Italy. All patients affected by grade I-IV POP, consisting of apical prolapse with or without cystocele, and who underwent laparoscopic Shull's technique for prolapse correction were enrolled. The endpoints to estimate the learning curve for the procedure were the percentage of laparoscopic procedures completed, operative time, and the early complication rate. Results A total of 31 laparoscopic Shull repairs were collected for the study. To evaluate the learning curve of the technique, we divided the 31 cases into three different groups: Procedures 0-10; 11-20; 21-31. The parameter for evaluating technique learning was the operative time. Group 21-31 demonstrated an operative time of 97 min (SD 20), compared with 121 min (SD 23) in group 0-10 and 120 min (SD 13) in group 11-20. A comparison of these means through ANOVA showed a p-value of 0.01 for the entire system, and 0.95 for the comparison between 0 and 10 and 11-20, 0.04 for 0-10 vs. 21-31, and 0.02 between 11 and 20 and 21-31. Conclusions The rate of surgical improvement in terms of time became effective after an average of 20 procedures. However, the improvement seems to be effective case by case for surgeons skilled in basic endoscopy.
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Affiliation(s)
- S. Cianci
- Unit of Gynecology and Obstetrics, Policlinico “G. Martino”, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - C. Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - G. Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - V. Palmara
- Unit of Gynecology and Obstetrics, Policlinico “G. Martino”, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - P. Romeo
- Unit of Gynecology and Obstetrics, Policlinico “G. Martino”, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - M. La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - A. S. Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - V. Capozzi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G. Andreoli
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - M. Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - M. Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Mao M, Fu H, Wang Q, Bai J, Zhang Y, Guo R. The effect of hysteropreservation versus hysterectomy on the outcome of laparoscopic uterosacral suspension in pelvic organ prolapse surgery. Maturitas 2023; 170:58-63. [PMID: 36773501 DOI: 10.1016/j.maturitas.2023.01.005] [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: 08/29/2022] [Revised: 11/14/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study compares the recurrence rate, complication rate and subjective satisfaction with laparoscopic uterosacral suspension with or without hysterectomy. STUDY DESIGN This retrospective cohort study included 105 patients between June 2014 and December 2019. Recurrent pelvic organ prolapse was defined as any prolapse to or beyond the hymen with straining or needing retreatment. Student's t-test, the Mann-Whitney U test, the chi square test or Fisher's exact test, multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used for the data analysis. MAIN OUTCOME MEASURES Whether the durability of laparoscopic uterosacral suspension surgery is affected by uterine preservation. RESULTS 60 patients underwent laparoscopic uterosacral suspension with concomitant hysterectomy (Hysterectomy group), and 45 underwent laparoscopic uterosacral hysteropexy (Hysteropexy group). The median (interquartile range) duration of follow-up for all 105 patients was 31 (22.5-47.5) months. The results of multivariate Cox proportional hazards regression showed that no difference was found in the risk of overall recurrence between the hysterectomy and hysteropexy groups (25 % vs. 22 %; HR, 0.37; 95 % CI, 0.14-1.00). Kaplan-Meier survival analysis also demonstrated that there were no significant differences in the overall rates of recurrent prolapse between the two groups (P = 0.30). In addition, the subjective success rates were high in both groups (82 %). CONCLUSIONS Our study demonstrated equally satisfactory objective and subjective long-term outcomes after laparoscopic uterosacral suspension with or without hysterectomy. Laparoscopic uterosacral hysteropexy can be safely and effectively offered to patients with pelvic organ prolapse who wish to preserve their uterus and do not have contraindications.
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Affiliation(s)
- Meng Mao
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanlin Fu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qian Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Bai
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Zhang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Guo
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Campagna G, Panico G, Lombisani A, Vacca L, Caramazza D, Scambia G, Ercoli A. Laparoscopic uterosacral ligament suspension: a comprehensive, systematic literature review. Eur J Obstet Gynecol Reprod Biol 2022; 277:57-70. [PMID: 36007356 DOI: 10.1016/j.ejogrb.2022.08.006] [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: 06/10/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Laparoscopic uterosacral ligament suspension (LUSLS) of the vaginal apex for the treatment of pelvic organ prolapse (POP) has gained popularity. The aim of this systematic review is to investigate perioperative outcomes and complications, subjective and objective success rates and recurrence rates in women undergoing this surgical procedure. STUDY DESIGN A systematic literature search was performed in December 2021. The critical appraisal skills program (CASP) was used to assess the methodological quality of the selected studies. The Clavien-Dindo (CD) scale and the Satava scale were used to classify periprocedural complications. Continuous variables were described as means and standard deviations while categorical were expressed as percentages of the whole group. Statistical significance was set at p < 0.05. RESULTS 26 articles were selected and analysed, with a total population of 1401 patients. Anatomical and subjective success rates after LUSLS ranged from 79% and 100% and from 76.2% to 100% respectively. The re-operation rate varied from 2% to 4.5% in the largest cohorts. The overall complication rate was 13.6%, however grade III CD complications occurred only in 1% of patients. Ureteral complications were described in only 2 cases. CONCLUSIONS LUSLS represent a safe and effective technique for vaginal apex resuspension in women with POP. Further larger prospective randomized studies are required to confirm these data.
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Affiliation(s)
- Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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Panico G, Vacca L, Campagna G, Lombisani A, Caramazza D, Caporale N, Scambia G, Ercoli A. Quality of life recovery after laparoscopic high uterosacral ligament suspension: a single centre observational study. Eur J Obstet Gynecol Reprod Biol 2021; 260:212-217. [PMID: 33862432 DOI: 10.1016/j.ejogrb.2021.03.035] [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] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Laparoscopic high uterosacral ligament suspension (l-HUSLS) is a laparoscopic-transposed vaginal technique for the treatment of pelvic organ prolapse. Nowadays data regarding quality of life and sexual functions in patients who underwent l-HUSLS for pelvic organ prolapse are few and generic with most of the study investigating the anatomical outcome. For these reasons, the aim of our study is to evaluate these subjective outcomes in women undergoing this surgical procedure with the support of validated questionnaires. STUDY DESIGN This is a retrospective study with the primary aim of analysing the quality of life, sexual function, patient satisfaction rates and anatomical outcome among patients who underwent l-HUSLS in our institution. The SPSS Version 26.0 for Windows (Statistical package for the social studies, Chicago, IL, USA) was used for the statistical analysis. RESULTS A total of 60 patients underwent l-HUSLS between 2016 and 2018. All patients had a high grade of apical prolapse. No intraoperative and major postoperative complications were registered. The median follow-up was 24 months (24-48). PGI-I score was 1-2 in 55 (91.6 %) women. We observed a significant improvement of EQ-5D index and VAS scores from the baseline to the 2 years follow-up: from 0.72 (0.67-1) to 0.91 (0.79-1) and from 50 (30-90) to 70 (50-100) respectively (p = 0.000). All women showed a statistically significant amelioration of FSDS and ICIQ-SF scores. Anatomical success rate after 24 months was 83.7 %. CONCLUSIONS l-HUSLS appears to be a safe, feasible and effective treatment for advanced pelvic organ prolapse with high rates of patient self-reported cure.
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Affiliation(s)
- Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Nicola Caporale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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