Why complex pelvic organ prolapse should be approached abdominally

Exploration of the safe suture area of the presacral space in sacrocolpopexy by 3-dimensional (3D) models reconstructed from CT

INTRODUCTION AND HYPOTHESIS

The objective of this study, a digital in vivo anatomical study based on patient-specific three-dimensional (3D) models reconstructed from computed tomography (CT) scans, was to clarify the anatomy of the presacral space and suggest a safe area for complication-free graft or mesh fixation.

METHODS

We retrospectively studied 182 CT angiography (CTA) datasets from Han Chinese women examined for gynecological diseases from January 2018-June 2020; we used Mimics 21.0 to create 176 3D models of the female presacral space. The distances of pelvic structures from the presacral vessels and ureters were standardized and measured in 3D mode.

RESULTS

The distances from the median sacral artery (MSA) to the bilateral great vessels and bilateral ureters at the sacral promontory (SP) level were similar to the respective distances from the midpoint of the SP (MSP) to those four structures (p > 0.05). At the level of the first transverse line, when the MSA was right of the midline, the MSA was 20.74 ± 3.86 mm from the medial edge of the left first anterior sacral foramen. When the MSA was left of the midline, its average distance from the medial edge of the right first anterior sacral foramen was 20.89 ± 4.92 mm. The SP was 9.71 ± 4.49 mm and 40.39 ± 6.74 mm, respectively, from the first and second sacral transverse veins along the midline.

CONCLUSIONS

To preserve important vasculature, we recommend a 30 × 20-mm (L × W) avascular rectangular-shaped area, 10 mm below the SP and alongside the MSA, for safe graft or mesh attachment during sacrocolpopexy.

Robotic-assisted sacrocolpopexy for pelvic organ prolapse

The demand for surgical correction of pelvic organ prolapse is expected to grow as the aging population remains active and focused on quality of life. Definitive correction of pelvic organ prolapse can be accomplished through both vaginal and abdominal approaches. This article provides a contemporary reference source that specifically addresses the historical framework, diagnostic algorithm, and therapeutic options for the treatment of female pelvic organ prolapse. Particular emphasis is placed on the role and technique of abdominal-based reconstruction using robotic technology and the evolving controversy regarding the use of synthetic vaginal mesh.

Outcomes of robotic sacrocolpopexy using barbed delayed absorbable sutures

STUDY OBJECTIVE

To evaluate 1-year outcomes of robotic sacrocolpopexy (RSC) for pelvic organ prolapse using barbed delayed absorbable sutures.

DESIGN

Retrospective cohort study (Class II-3).

SETTINGS

University-based hospital in Southeast Texas.

PATIENTS

Patients with symptomatic apical pelvic organ prolapse who underwent RSC using barbed delayed absorbable sutures between January 2011 and August 2012. Patients were examined postoperatively at least twice (after 6 weeks and 1 year).

INTERVENTIONS

RSC procedure.

MEASUREMENTS AND MAIN RESULTS

The study included a total of 20 patients, of them 15 had grades 3 or 4 whereas 5 had grade 2 apical defects according to the Baden-Walker classification system. Fourteen patients (70%) underwent concomitant hysterectomy while 9 (45%) underwent concomitant anti-incontinence surgery. Mesh suturing times were 46.9 ± 12.6 and 20.5 ± 9.3 minutes in the first 10 versus the last 10 cases, respectively (p < .001). The mean follow-up duration was 17.3 months (range, 12-24 months). There were no recurrences of apical defects or mesh/suture exposure/erosion. However, 1 patient developed a grade 2 cystocele, and another developed new-onset urinary incontinence, both after 1 year. A third patient's urine leakage did not improve postoperatively. Lastly, a fourth patient developed port site incisional hernia and underwent repair 5 months later.

CONCLUSION

Our study suggests that barbed delayed absorbable sutures are safe and effective in RCS procedures over 1 year. Larger, comparative, and randomized trials are recommended for definitive conclusions.