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Yu T, Liu L. The standardized procedure, technical key points and latest progress of laparoscopic lateral suspension surgery. Arch Gynecol Obstet 2024; 310:1745-1748. [PMID: 39136730 DOI: 10.1007/s00404-024-07686-w] [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: 05/02/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a common condition that can affect up to 30% of women over the age of 50. For a long time, open abdominal and laparoscopic sacrocolpopexy (LSCP) have been considered the gold standard in the treatment of apical pelvic organ prolapse (POP). Promontory dissection may expose patients to potential life-threatening intraoperative vascular injuries, as well as damage to sacral roots or the hypogastric nerve. Laparoscopic lateral suspension could be considered as an alternative to LSCP in the treatment of POP due to its favorable objective and subjective outcomes. The aim of this article is to demonstrate a step-by-step approach to laparoscopic lateral suspension for POP with the goal of standardizing this procedure. Technical key points and the latest progress are summarized to provide a reference for subsequent gynecological and urological surgeons. METHOD According to our surgical experience of our hospital, demonstrate a step-by-step approach and highlight technical key points for laparoscopic lateral suspension for POP with the aim of standardizing this procedure. CONCLUSION LLS with mesh is a safe alternative to laparoscopic sacropexy and is very well suited for uterine-preserving POP surgery. Nevertheless, this novel procedure lacks standardization. Standardization of procedures is necessary to reduce failure rates, generate impactful research data, and enhance patient safety. This article contributes to the standardization of this procedure, and we believe our article will be useful in assisting future gynecological and urological surgeons in performing this procedure.
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Affiliation(s)
- Tengge Yu
- Department of Gynecology and Obstetrics, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Li Liu
- Department of Emergency, The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang, China.
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Şahin F, Özdemir S, Doğan O. Should sacrouterine plication be added to lateral suspension surgery? A prospective study. J Obstet Gynaecol Res 2024; 50:1042-1050. [PMID: 38627198 DOI: 10.1111/jog.15941] [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: 01/16/2024] [Accepted: 03/26/2024] [Indexed: 06/04/2024]
Abstract
AIM Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. METHODS Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. RESULTS In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). CONCLUSIONS The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.
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Affiliation(s)
- Fatih Şahin
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Savaş Özdemir
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Clinic, Istanbul, Turkey
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Sayed E, Mitwally A, Abdelmagied A, Fetih A, Fekry M. Transperineal Ultrasound Evaluation of Bladder Parameters in Patients with Apical Prolapse Undergoing Lateral Suspension or Sacropexy. J Obstet Gynaecol India 2024; 74:170-175. [PMID: 38707876 PMCID: PMC11065794 DOI: 10.1007/s13224-023-01912-2] [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: 03/24/2023] [Accepted: 11/14/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction and hypothesis.We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy. Methods We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits. Results In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling. Conclusion LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS. Clinical Trial Registration Clinical trial ID: NCT03772691.
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Affiliation(s)
- Ezzat Sayed
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Abubakr Mitwally
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Ahmed Abdelmagied
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Ahmed Fetih
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
| | - Mohamed Fekry
- Department of Obstetrics and Gynaecology, Women’s Health Hospital, Asyut University, Asyut, Egypt
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Malanowska-Jarema E, Starczewski A, Melnyk M, Oliveira D, Balzarro M, Rubillota E. A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results. J Clin Med 2024; 13:1348. [PMID: 38592190 PMCID: PMC10931691 DOI: 10.3390/jcm13051348] [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: 11/22/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. METHODS Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. RESULTS A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien-Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. CONCLUSIONS LLS is a good alternative to LSC, with promising anatomical and quality-of-life results.
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Affiliation(s)
- Ewelina Malanowska-Jarema
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Mariia Melnyk
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Dulce Oliveira
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy; (M.B.); (E.R.)
| | - Emanuel Rubillota
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy; (M.B.); (E.R.)
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Malanowska-Jarema E, Osnytska Y, Starczewski A, Balzarro M, Rubilotta E. A comparative study in learning curves of laparoscopic lateral suspension vs. laparoscopic sacrocolpopexy: preliminary results. Front Surg 2023; 10:1274178. [PMID: 38125583 PMCID: PMC10731022 DOI: 10.3389/fsurg.2023.1274178] [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: 08/07/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Determination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves of different techniques in laparoscopic pelvic floor surgery. Objective The aim of this study was to compare the learning curve of two operative techniques, laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC). Material and methods We conducted a prospective study to assess the learning curve of LLS and LSC by implementing a structured urogynecologic surgical training program with the use of pelvic trainers for our urogynecology fellow. The fellow was an experienced urogynecologic surgeon, but was laparoscopic suturing and dissection naive at the beginning of the study. She was required to assist in 20 laparoscopic urogynecologic surgeries and undertake laparoscopic suturing and knot tying training with mesh positioning on a laparoscopic trainer for 4 h/week during the trial period. After the completion of this structured training program, the fellow performed LLS and LSC under the supervision of an experienced subspecialist as the primary surgeon. Linear regression analysis was used to compare the data of LLS and LSC learning curves. Subjective pre- and post-operative evaluation of pelvic organ prolapse (POP) and pelvic floor disorders was undertaken preoperatively and 12 months postoperatively using the PFDI-20-Quality of Life validated questionnaire. Follow-up was scheduled 12 months after the surgery and performed by a skilled urogynecologist. Objective cure was defined as Pelvic Organ Prolapse-Qualification (POP-Q) stage Results The mean operative times of laparoscopic sacrocolpopexy and lateral suspension were 168.26 and 160.33 min, respectively. According to linear regression analysis after 43 procedures, the learning curve for laparoscopic lateral suspension was shorter than for laparoscopic sacrocolpopexy (OPTime 134.69 min). In both groups, there was a significant reduction in bothersome POP symptoms (p ≤ 0.005). Bladder injuries in two cases and lumbar pain in one case were recorded during the study. Overall objective success at 12 months was 90.7% for LSC and 89.1% for LLS. Conclusion Laparoscopic lateral suspension could be an alternative to laparoscopic sacrocolpopexy in the treatment of POP with its good objective and subjective outcomes. Lateral suspension has a shorter learning curve, and it is technically less demanding than LSC. Procedure-dedicated training can accelerate the move from a novice to a master laparoscopic surgeon.
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Affiliation(s)
- Ewelina Malanowska-Jarema
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Yana Osnytska
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Ketenci Gencer F, Salman S, Kumbasar S, Bacak HB, Khatib O, Kaya C, Yildiz E, Coskun ES. Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique. Int Urogynecol J 2023; 34:1583-1591. [PMID: 36625926 DOI: 10.1007/s00192-022-05433-w] [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: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. METHODS This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. RESULTS Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). CONCLUSIONS With the Salman-Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.
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Affiliation(s)
- Fatma Ketenci Gencer
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Suleyman Salman
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey.
| | - Serkan Kumbasar
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Havva Betul Bacak
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Ozlem Khatib
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Cihan Kaya
- Acibadem Bakirkoy Hospital, Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Elif Yildiz
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Enes Serhat Coskun
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
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Baki Erin K, Taştan AŞ, Katırcı Y, Özdemir AZ, Güven D, Önem K, Önal M, Erin R, Kulaksiz D. Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study. Arch Gynecol Obstet 2023; 307:1859-1865. [PMID: 36808287 DOI: 10.1007/s00404-023-06958-1] [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: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.
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Affiliation(s)
- Kübra Baki Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey.
| | - Ayşe Şeyma Taştan
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Yunus Katırcı
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayşe Zehra Özdemir
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Davut Güven
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Kadir Önem
- Department of Urology, Medicine Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Mesut Önal
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Recep Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Deniz Kulaksiz
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
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Aksin Ş, Andan C. Postoperative results of laparoscopic lateral suspension operation: A clinical trials study. Front Surg 2023; 10:1069110. [PMID: 36793321 PMCID: PMC9924084 DOI: 10.3389/fsurg.2023.1069110] [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: 10/13/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background Pelvic organ prolapse surgery carries potential risks, and Laparoscopic lateral suspension (LLS) surgery is being performed in increasing numbers with advances in minimally invasive surgery. Our study aims to report the postoperative results of LLS operations. Patients and Methods 41 patients at POP Q stage 2 and above underwent LLS operations in a tertiary center between 2017 and 2019. Postoperative patients 12 (12-37) months and older were evaluated in terms of anterior and apical compartments. Results In our study, laparoscopic lateral suspension (LLS) was applied to 41 patients. The mean age of all patients was 51.45 ± 11.51, and the operation time was 71.13 ± 18.70 min, The mean hospital stay was 1.35 ± 0.4 days. The apical compartment success rate was 78% and the anterior compartment success rate was 73%. In terms of patient satisfaction, 32 (78.1%) patients were satisfied, While 37 (90.1%) patients did not have abdominal mesh pain, 4 (9.9%) patients had mesh pain. Dyspareunia was not observed. Conclusions Laparoscopic lateral suspension in pop surgery; Considering the success rate below expectation, some patient groups can be applied as an alternative surgical method.
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Affiliation(s)
- Şerif Aksin
- Obstetrics and Gynecology Department, Fakulty of Medicine, Siirt University, Siirt, Turkey,Correspondence: Şerif Aksin
| | - Cengiz Andan
- Obstetrics and Gynecology Department, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
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Kumbasar S, Salman S, Sogut O, Gencer FK, Bacak HB, Tezcan AD, Timur GY. Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse. J Obstet Gynaecol Res 2023; 49:341-349. [PMID: 36196844 DOI: 10.1111/jog.15459] [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: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023]
Abstract
AIM Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. METHODS LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. RESULTS The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p ˂ 0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. CONCLUSION LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.
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Affiliation(s)
- Serkan Kumbasar
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Suleyman Salman
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ozlem Sogut
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Fatma K Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Havva B Bacak
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Ayse D Tezcan
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
| | - Gözde Y Timur
- Department of Obstetrics and Gynecology, Gaziosmanpasa Research and Training Hospital affiliated with the University of Health Sciences, Istanbul, Turkey
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Wang J, Xu X, Xu J. Modified laparoscopic high uterosacral ligament suspension for treatment of apical prolapse: A feasibility study. J Obstet Gynaecol Res 2022; 48:2918-2925. [DOI: 10.1111/jog.15393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jing Wang
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
| | - Xiaomin Xu
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
| | - Jingui Xu
- Department of Gynecology The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital Quzhou China
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Campagna G, Vacca L, Panico G, Caramazza D, Lombisani A, Scambia G, Ercoli A. Laparoscopic lateral suspension for pelvic organ prolapse: A systematic literature review. Eur J Obstet Gynecol Reprod Biol 2021; 264:318-329. [PMID: 34364019 DOI: 10.1016/j.ejogrb.2021.07.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. OBJECTIVES The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic). SEARCH STRATEGY Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science. DATA COLLECTION AND ANALYSIS Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively. MAIN RESULTS Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%. CONCLUSIONS Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well-designed, randomized, controlled trials are required to confirm this 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 e 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 e 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 e 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 e 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 e 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 e 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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Alay I, Kaya C, Cengiz H, Yildiz S, Aslan O, Yasar L, Ekin M. Apical pelvic organ prolapse repair via vaginal-assisted natural orifice transluminal endoscopic surgery: Initial experience from a tertiary care hospital. Asian J Endosc Surg 2021; 14:346-352. [PMID: 32967055 DOI: 10.1111/ases.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/23/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair. METHODS After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow-up visits, including complications and anatomical results, were also recorded. RESULTS The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24-hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery. CONCLUSION As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.
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Affiliation(s)
- Ismail Alay
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Cengiz
- Department of Obstetrics and Gynecology, Istanbul Aydin University Faculty of Medicine, Istanbul, Turkey
| | - Sukru Yildiz
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Aslan
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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13
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Pulatoğlu Ç, Yassa M, Turan G, Türkyılmaz D, Doğan O. Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study. Int Urogynecol J 2020; 32:851-858. [PMID: 33175232 DOI: 10.1007/s00192-020-04596-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. METHODS Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. RESULTS The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). CONCLUSION The vaginal axis was found to be near-normal in patients who underwent LLMS.
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Affiliation(s)
- Çiğdem Pulatoğlu
- Department of Obstetrics and Gynecology, Istinye University Hospital Gaziosmanpaşa Medical Park, Merkez mahallesi Hanımefendi Sokak 105/5 Şişli, İstanbul, Turkey.
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sancaktepe Şehit Professor İlhan Varank Training And Research Hospital, Acıbadem Mahallesi Nakkaş Sokak 26/4 Üsküdar, İstanbul, Turkey
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Türkyılmaz
- Department of Radiology, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Radiology, Health Sciences University, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Clinic, 19 mayıs mah. Binbaşı Refik sok. 20/12 Şişli, İstanbul, Turkey
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