Robotic mesh-supported pectopexy for pelvic organ prolapse: expanding the options of pelvic floor repair

Evaluation of the effectiveness of laparoscopic pectopexy in advanced stage apical prolapse

OBJECTIVE

We aimed to investigate the effectiveness of the laparoscopic pectopexy procedure in women who want to preserve their uterus for stage III or IV apical prolapse.

STUDY DESIGN

132 women who underwent laparoscopic pectopexy due to stage III or IV apical pelvic organ prolapse (POP) were included in this study. Demographic data of the patients, duration of surgery, blood loss, hospitalisation, intraoperative and postoperative complications, recurrence rate were searched from the hospital file archive. Pelvic organ prolapse quantification (POP-Q) system was used at postoperative control visits. The patients' quality of life was evaluated by comparing the results of the pelvic organ quality of life (P-QOL) questionnaire which they filled out at the preoperative and 6th months later.

RESULTS

The patients' mean age was 60(52-66)years. The average duration of the surgery was 110(90-150) minutes. Average blood loss was 150(75-220) ml. No intraoperative or postoperative complications were noted. The average hospitalisation was 2(1-3) days. The average follow-up period was 19 (13-26) months. Apical prolapse recurrence was observed in 3 (2.2 %) patients and laparoscopic sacrohysteropexy was performed. There was a significant improvement in the POP-Q scores of the patients in the postoperative period (p < 0.0001). A significant improvement was detected in the P-QOL total score and all each paramaters after surgery (p < 0.0001).

CONCLUSION

Laparoscopic pectopexy seems to be a reliable and efficient method for patients in advanced stages apical prolapse whom wants to preservation of the uterus.With all the advantages of minimally invasive surgery, it increases the patients' quality of life.

Role of lateral suspension for the treatment of pelvic organ prolapse: a Delphi survey of expert panel

INTRODUCTION AND HYPOTHESIS

Lateral suspension is an abdominal prosthetic surgical procedure used to correct apical prolapse. The procedure involves the placement of a T-shaped mesh on the anterior vaginal wall and on the isthmus or uterine cervix that is suspended laterally and posteriorly to the abdominal wall. Since its description in the late 90s, modifications of the technique have been described. So far, no consensus on the correct indications, safety, advantages, and disadvantages of this emerging procedure has been reached.

METHODS

A modified Delphi process was used to build consensus within a group of 21 international surgeons who are experts in the performance of laparoscopic lateral suspension (LLS). The process was held with a first online round, where the experts expressed their level of agreement on 64 statements on indications, technical features, and other aspects of LLS. A subsequent re-discussion of statements where a threshold of agreement was not reached was held in presence.

RESULTS

The Delphi process allowed the identification of several aspects of LLS that represented areas of agreement by the experts. The experts agreed that LLS is a safe and effective technique to correct apical and anterior prolapse. The experts highlighted several key technical aspects of the procedure, including clinical indications and surgical steps.

CONCLUSIONS

This Delphi consensus provides valuable guidance and criteria for the use of LLS in the treatment of pelvic organ prolapse, based on expert opinion by large volume surgeons' experts in the performance of this innovative procedure.

Retrospective analysis of apical prolapse correction by unilateral pectineal suspension: perioperative and short-term results

INTRODUCTION AND HYPOTHESIS

We have previously published the novel method of unilateral pectineal suspension (UPS) for apical prolapse correction. UPS provides mesh-free midline uterus suspension using a single non-absorbable suture to attach the anterior cervix to the lateral part of the iliopectineal ligament. The purpose of this retrospective cohort study was to analyze the short-term efficacy, perioperative complication rate, and overall patient acceptance of the new UPS surgical concept.

METHODS

Forty-seven patients with POP-Q stage 2-4 who underwent robotic UPS between January 1, 2020 and December 31, 2021 were included in the study. Patient data were taken retrospectively from the patient files. Treatment success was the primary endpoint, measured both objectively using a defined composite endpoint and subjectively according to patients' acceptance 3-6 months after surgery during a follow-up examination. Secondary outcome measures included complications and conversions, and effect of additional procedures on operative time.

RESULTS

Treatment success as measured by the defined composite endpoint was 93.6% for the entire cohort. No complications or conversions occurred. Mean operation time for isolated UPS was 46.5 min (n = 33 patients). UPS can be easily combined with additional surgical procedures for repair of remaining pelvic floor defects, incontinence surgery or other indications. Additional procedures performed had a significant influence on operation time (p < 0.0005, n = 14).

CONCLUSIONS

UPS shows highly favorable results when looking at an unselected cohort of patients in need of primary POP surgery with respect to established quality parameters of POP repair.

Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse

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.