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Lu Z, Chen Y, Wang X, Li J, Yang C, Yuan F, Hua K, Hu C. Mesh Exposure and Prolapse Recurrence Following Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Sacrocolpopexy: Over 24 Months of Follow-up Data. J Minim Invasive Gynecol 2022; 29:1317-1322. [PMID: 35964942 DOI: 10.1016/j.jmig.2022.08.001] [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: 03/29/2022] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To describe the results of mesh exposure and prolapse recurrence of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrocolpopexy after more than 24 months of postoperative follow-up. DESIGN A retrospective cohort study. SETTING A university hospital. PATIENTS Women with uterine prolapse who underwent vNOTES sacrocolpopexy with an ultralightweight polypropylene mesh between May 2018 and March 2020. INTERVENTIONS vNOTES sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS Of 57 women, 55 women (96.5%) were included in the final analysis. The mean follow-up duration was 35.5 ± 7.6 (24-46) months. The total incidence of mesh exposure was 3 of 55 (5.5%). The total incidence of prolapse recurrence was 3 of 55 (5.5%). The changes in the Pelvic Organ Prolapse Quantification System scores, including Aa, Ba, C, Ap, Bp, and total vaginal length values, showed significant improvement after surgery (p <.05 for all). CONCLUSION The study demonstrates that vNOTES sacrocolpopexy appears to be an effective option with low risks of mesh exposure and prolapse recurrence. Studies including more patients and longer follow-up periods should be performed before a clear conclusion can be reached.
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Affiliation(s)
- Zhiying Lu
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yisong Chen
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaojuan Wang
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junwei Li
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chen Yang
- Departments of Anesthesiology (Dr. Yang), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Feng Yuan
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Changdong Hu
- Departments of Gynecology (Drs. Lu, Chen, Wang, Li, Yuan, Hua, and Hu), Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Nam G, Lee SR, Roh AM, Kim JH, Choi S, Kim SH, Chae HD. Single-Incision vs. Multiport Robotic Sacrocolpopexy: 126 Consecutive Cases at a Single Institution. J Clin Med 2021; 10:jcm10194457. [PMID: 34640475 PMCID: PMC8509716 DOI: 10.3390/jcm10194457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Robot-assisted laparoscopic sacrocolpopexy (RSC) has gained popularity as a method for easier intracorporeal suturing than conventional laparoscopic sacrocolpopexy. However, few studies have compared multiport RSC (MP-RSC) and single-incision RSC (SI-RSC). We aimed to compare perioperative outcomes between these techniques for advanced pelvic organ prolapse (POP). We analyzed 126 patients who underwent RSC for POP quantification (all stage III to IV) between March 2019 and May 2021 at Seoul Asan Medical Center. We prospectively collected operation-related data, including total operation time (OT; from skin incision to closure) and perioperative outcomes. A total of 106 and 20 patients underwent MP-RSC and SI-RSC, respectively. The mean ages were 57.49 ± 10.89 and 56.20 ± 10.30 years in the MP-RSC and SI-RSC groups, respectively. The mean total OT was significantly shorter for MP-RSC than for SI-RSC (105.43 ± 24.03 vs. 121.10 ± 26.28 min). The OT difference was 15.67 min (95% confidence interval, 3.90-25.85, p = 0.009). No statistically significant differences were observed in terms of perioperative variables (estimated blood loss, hospital stay) and postoperative adverse events (POP recurrence, mesh erosion). SI-RSC had comparable intraoperative and postoperative outcomes to MP-RSC, with additional cosmetic benefits. MP-RSC had significantly shorter OT than SI-RSC.
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Affiliation(s)
- Gina Nam
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul 06973, Korea;
| | - Sa-Ra Lee
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
| | - A-mi Roh
- Department of Obstetrics and Gynecology, Wonder Women’s Clinic, 1074, Gyeongui-ro, Paju-si 10908, Gyeonggi-do, Korea;
| | - Ju-Hee Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Sungwook Choi
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Sung-Hoon Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
| | - Hee-Dong Chae
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.C.); (S.-H.K.); (H.-D.C.)
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Nam G, Lee SR. Congenital Uterine Anomaly and Pelvic Organ Prolapse: A Rare Case of Pelvic Organ Prolapse in a Complete Bicornuate Uterus with Successful Pregnancy Outcomes Undiagnosed until the Time of Sacrocolpopexy. J Menopausal Med 2021; 27:32-36. [PMID: 33942587 PMCID: PMC8102811 DOI: 10.6118/jmm.21007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022] Open
Abstract
Müllerian development anomalies (MDAs) are most commonly diagnosed in the reproductive period. A bicornuate uterus is the result of a fusion defect of the Müllerian ducts, causing an abnormal fundal outline. Most of the cases are diagnosed early in life and present with obstetrical complications, such as recurrent pregnancy loss, preterm birth, intrauterine growth restriction, placental abruption, and cervical incompetence. Pelvic organ prolapse (POP) in women with MDAs has been reported; however, all reported cases were when MDAs are diagnosed before or simultaneously with the development of POP in premenopausal young women aged < 35. A 52-year-old menopausal woman, who successfully delivered vaginally at term, was presented with protruding mass through vaginal introitus. On POP-Q examination, the cervix was elongated and descended to 1 cm out of the hymen during bearing down; however, the uterine bodies were confined in the pelvic cavity, which is commonly encountered among POP patients with large uterus due to uterine fibroids or adenomyosis. She also diagnosed for complete bicornuate uterus and underwent robotic sacrocolpopexy for advanced stage POP. It is presumed to have been caused by the bicornuate uterus that prevented the total uterine prolapse with the effect of extending both uterine horns bilaterally inside the pelvic cavity and trapping the uterus within the pelvis. Herein, we report a rare case of complete bicornuate uterus with multiple successful vaginal deliveries at term without obstetric complications, which remained undiagnosed until she was managed for the POP in her postmenopausal period.
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Affiliation(s)
- Gina Nam
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Lee SR, Kim JH, Kim SH, Chae HD. New "Wrinkle Method" for Intracorporeal Anterior Vaginal Wall Plication during Sacrocolpopexy. J Clin Med 2021; 10:jcm10091822. [PMID: 33922086 PMCID: PMC8122603 DOI: 10.3390/jcm10091822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
In this study, we introduce a new wrinkle method for intracorporeal anterior vaginal wall plication during sacrocolpopexy for pelvic organ prolapse (POP) aiming to decrease POP recurrence and postoperative vaginal wall mesh erosion. The wrinkle method was performed using robotic sacrocolpopexy (RSC) on 57 symptomatic POP patients. Sixty-six patients underwent conventional RSC before the development of the wrinkle method. Feasibility and perioperative outcomes were compared. The wrinkle method is not time consuming. The total operative time was shorter in the wrinkle group than in the non-wrinkle group; however, this was attributed to lower adhesiolysis in the wrinkle group. No differences were recorded in the mean estimated blood loss and complication rates between the two groups. In conclusion, although we were unable to confirm that the wrinkle method decreased POP recurrence and vaginal wall mesh erosion after RSC because of the short follow-up period, our preliminary findings are positive in terms of safety. Further long-term well designed randomized controlled trials are required to elucidate the benefits of the wrinkle method.
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Affiliation(s)
- Sa Ra Lee
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
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