1
|
Lee JN, Yim MH, Na YJ, Song YJ, Kim HG. Comparison of laparoscopic hysteropectopexy and vaginal hysterectomy in women with pelvic organ prolapse. Minerva Obstet Gynecol 2024; 76:257-263. [PMID: 36786782 DOI: 10.23736/s2724-606x.23.05236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND To study whether laparoscopic hysteropectopexy (LHP) can be substituted for vaginal hysterectomy (VH) in patients with pelvic organ prolapse (POP), we compared VH with the relatively new procedure, LHP. METHODS This retrospective study included 176 women who underwent LHP (N.=54) or VH (N.=122) for a Pelvic Organ Prolapse Quantification (POP-Q) System stage 2 or higher pelvic organ prolapse between January 2011 and December 2019. We compared the surgical outcomes and overall rate of complications between the two groups. RESULTS The average length of hospitalization was 5.28 days for the LHP group and 7.08 days for the VH group. EBL (mL) in the LHP group was 32.2, whereas it was 47.7 in the VH group. The average operation time (min) was 68.2 in the LHP group and 98.9 in the VH group. Twenty-seven patients (22.1%) in the VH group had postoperative voiding difficulty compared with 2 patients (3.7%) in the LHP group. The overall number of intraoperative complications was 6 (11%) in the LHP group and 34 (27.9%) in the VH group. CONCLUSIONS This study demonstrated that LHP is more effective than VH in patients with POP. However, since the number of cases was small and retrospective studies are limited, we recommend a randomized controlled trial to be conducted in the future to confirm our results.
Collapse
Affiliation(s)
- Ji N Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University, Yangsan, South Korea
| | - Mi H Yim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University, Yangsan, South Korea
| | - Yong J Na
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University, Yangsan, South Korea
| | - Yong J Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University, Yangsan, South Korea
| | - Hwi G Kim
- Department of Obstetrics and Gynecology, Pusan National University College of Medicine, Yangsan, South Korea -
| |
Collapse
|
2
|
Yang Y, Li Z, Si K, Dai Q, Qiao Y, Li D, Zhang L, Wu F, He J, Wu G. Effectiveness of Laparoscopic Pectopexy for Pelvic Organ Prolapse Compared with Laparoscopic Sacrocolpopexy. J Minim Invasive Gynecol 2023; 30:833-840.e2. [PMID: 37369345 DOI: 10.1016/j.jmig.2023.06.011] [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: 01/29/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
STUDY OBJECTIVE To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP). DESIGN Prospective cohort study. SETTING A tertiary hospital. PATIENTS We included 203 patients with POP. INTERVENTIONS Laparoscopic pectopexy or laparoscopic sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy. CONCLUSION Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.
Collapse
Affiliation(s)
- Yingying Yang
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Li
- Clinical Research Unit (Drs. Yang and Z. Li), Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Keyi Si
- Department of Military Health Statistics (Dr. Si), Naval Medical University, Shanghai, China
| | - Qingqiang Dai
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yingying Qiao
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dazhuang Li
- School of Public Health (Dr. D. Li), Fudan University, Shanghai, China
| | - Li Zhang
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jia He
- School of Medicine (Dr. He), Tongji University, Shanghai, China
| | - Guizhu Wu
- Department of Gynecology (Drs. Dai, Qiao, Zhang, F. Wu, and G. Wu), Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
| |
Collapse
|
3
|
Brasoveanu S, Ilina R, Balulescu L, Pirtea M, Secosan C, Grigoraș D, Chiriac D, Bardan R, Margan MM, Alexandru A, Pirtea L. Laparoscopic Pectopexy versus Vaginal Sacrospinous Ligament Fixation in the Treatment of Apical Prolapse. Life (Basel) 2023; 13:1951. [PMID: 37895333 PMCID: PMC10608133 DOI: 10.3390/life13101951] [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: 07/30/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES To compare the follow-up results of a sacrospinous ligament fixation (SSLF) technique for laparoscopic bilateral fixation of the vagina to the iliopectineal ligament via a PVDF-mesh (laparoscopic pectopexy technique, LP) in terms of cure rate and postoperative complications rate. MATERIAL AND METHODS This prospective study included 160 patients diagnosed with pelvic organ prolapse stage II-IV according to the POP-Q system. Eighty-two patients (51.25%) underwent vaginal sacrospinous ligament fixation and seventy-eight patients (48.75%) underwent the laparoscopic pectopexy procedure. RESULTS The cure rate was high in both groups, 95.12% of the patients (78 out of 82) in the SSLF group and 93.59% of the patients (73 out of 78) in the LP group were cured post surgery, leading to an overall cure rate of 151 out of 160 patients. Pelvic pain was present in 5.00% of all patients, but was notably more frequent in the SSLF group (7, 8.54%) than in the LP group (1, 1.28%). Dyspareunia occurred in 4.37% of all patients, slightly more frequently in the SSLF group (6, 7.32%) than the LP group (1, 1.28%), but without significant difference. CONCLUSIONS The laparoscopic pectopexy procedure has comparably positive follow-up results with the conventional sacrospinous ligament fixation procedure. Both SSLF and LP are effective in the treatment of pelvic organ prolapse, with favorable anatomical and subjective results, a high cure rate and low rates of serious postoperative complications.
Collapse
Affiliation(s)
- Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Razvan Ilina
- Department of Surgery, Discipline of Surgical Semiology II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Dorin Grigoraș
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Daniela Chiriac
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| | - Răzvan Bardan
- Department of Urology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Mădălin-Marius Margan
- Department of Functional Sciences, Discipline of Public Health, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Alexandru Alexandru
- General Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Laurențiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.B.); (L.B.); (M.P.); (C.S.); (D.G.); (D.C.); (L.P.)
| |
Collapse
|
4
|
Bolovis D, Brucker C. Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse. Facts Views Vis Obgyn 2022; 14:177-181. [DOI: 10.52054/fvvo.14.2.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation.
Materials and Methods: Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi ® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position.
Main outcome measures: For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system.
Results: Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored.
Conclusions: Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair.
Collapse
|
5
|
Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II-IV Apical Prolapse. J Clin Med 2022; 11:jcm11082215. [PMID: 35456313 PMCID: PMC9029245 DOI: 10.3390/jcm11082215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.
Collapse
|