Laparoscopic approaches to the retropubic space: three alternatives with anatomical considerations

Predictive Factors for Poor Outcome after Laparoscopic and Open Colposuspension: A Comparative Analysis Using the BSUG Database

INTRODUCTION

Colposuspension has been a well-accepted surgical treatment for stress urinary incontinence (SUI) since 1961. However, there is limited research on predictors of poor outcomes in both laparoscopic colposuspension (LC) and open colposuspension (OC) procedures. This study aimed to identify predictors linked to patient-reported failure after colposuspension.

METHODOLOGY

This was a retrospective cohort study of women who underwent their first colposuspension surgery. The data were collected prospectively on the British Society of Urogynaecology database. The primary outcome measure was the Patient Global Impression of Improvement (PGII) for incontinence; PGII score 3-7 was defined as failure.

RESULTS

A total of 3104 women (1181 in LC and 1923 in OC) were analysed. On multivariate analyses, having a cystocele stage ≥ 2 was significantly predictive of failure (OR 2.573, 95% CI 1.086-6.098; p = 0.032) in LC. In OC, previous midurethral sling (MUS) procedure (OR 1.807, 95% CI 1.169-2.795; p = 0.008) and previous prolapse surgery (OR 1.954, 95% CI 1.235-3.093; p = 0.004) independently, were significant predictors of failure. OC had higher success (better PGII) than LC (p < 0.001), whilst adverse events such as blood loss, rates of urinary retention and duration of admission (p < 0.001) were lower in LC.

CONCLUSION

Variables found to be independently significant for failed colposuspension were different in the two approaches. Previous pelvic organ prolapse surgery and/or midurethral sling appeared to be the most significant predictors for failed OC, whilst in the LC group, having a stage ≥ 2 cystocele was predictive of failure.

Preclinical safety testing and initial experience of a morcellation bag with four sealable ports

Electromechanical morcellation-so called power morcellation-is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11-24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4-14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20-194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13-896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0-39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.

Single-port laparoscopic percutaneous closure of the internal ring for scarless repair of inguinal hernias in girls

Purpose: The purpose of this study was to summarize the clinical experience with laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle for inguinal hernias in girls.Material and methods: A total of 462 girls with inguinal hernias participated in this study from January 2013 to June 2019. Laparoscopic percutaneous extraperitoneal closure of the internal ring via an epidural needle was used to treat these patients.Results: All 462 girls with an inguinal hernia successfully underwent laparoscopic surgery. The operative times for unilateral and bilateral inguinal hernias were 15 (11-25) minutes and 23 (18-33) minutes, respectively. All patients were discharged 1-2 days after the operations. During the hospitalization and follow-up periods, none of the following complications were observed: hernia recurrence, umbilical hernia, abdominal wall vascular injury, intestinal injury or bladder injury. However, there were six patients with complications: two cases of poor healing of the umbilical incision, three cases of suture granulomas and one case of groin traction pain and discomfort.Conclusion: Laparoscopic percutaneous extraperitoneal closure of the internal ring using an epidural needle is a safe and feasible method for the treatment of inguinal hernias in girls. This method has the advantages of limited trauma, no scarring and a good cosmetic effect.