Article

Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches.

Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, 695 Eddy Street, Suite 12, Providence, RI 02903, USA.
The Journal of reproductive medicine (Impact Factor: 0.58). 05/2009; 54(5):273-80.
Source: PubMed

ABSTRACT To compare the risk of ureteral compromise and of recurrent vault prolapse following vaginal vs. laparoscopic uterosacral vault suspension at the time of vaginal hysterectomy.
In this retrospective, cohort study, uterosacral ligament suspension was performed using either a vaginal or laparoscopic approach. The primary outcome was intraoperative ureteral compromise; secondary outcomes were postoperative anatomic result and recurrent prolapse. The Canadian Task Force Classification was II-2.
One hundred eighteen patients were included: 96 patients in the vaginal group and 22 patients in the laparoscopic group. Ureteral compromise was identified intraoperatively in 4 (4.2%) cases in the vaginal group; no ureteral compromise was observed in the laparoscopic group (p = 0.33). Failure at the apex, defined as stage > or = II for point C, was seen in 6.3% of patients in the vaginal group as compared with 0% in the laparoscopic group; this difference did not achieve statistical significance. Similarly, trends toward lower recurrent symptomatic vault prolapse (10% vs. 0%), any symptomatic prolapse recurrence (12.5% vs. 4.6%), and higher postoperative Pelvic Organ Prolapse Quantification point C were observed in the laparoscopic group (p > 0.05 for all).
Laparoscopic uterosacral vault suspension following vaginal hysterectomy is a safe alternative to the vaginal approach.

0 Followers
 · 
156 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe our techniques, outcomes, and complications with laparoscopic procedures for correcting pelvic organ prolapse (POP). We hypothesized that laparoscopic abdominal sacrocolpopexy (ASC) gives better anatomic results than laparoscopic uterosacral ligament suspension (USLS), without increased complications. This was a retrospective cohort study of 290 patients who underwent laparoscopic suspensions in a 2-year period. Anatomic measurements using the Pelvic Organ Prolapse Quantification (POP-Q) system were collected. Subjective data were obtained from the Pelvic Floor Distress Inventory Short-Form 20 (PFDI) questionnaire. The anatomic improvement for each stage and complication rates were analyzed. The difference in the risk of mesh erosion between patients undergoing concomitant total hysterectomy and those who had a prior hysterectomy was determined. In 102 patients with stage 2 prolapse, a comparison between ASC and USLS in anatomic and subjective results and complication rates was performed. Anatomic success rates ranged between 86 % and 95 %. Overall mesh erosion rate was 1.2 %, showing no difference between concomitant total laparoscopic hysterectomy (0 %) and prior hysterectomy (2.1 %, p = 0.155). ASC resulted in statistically significantly better anterior-compartment support than USLS (p = 0.043). There was no difference in apex or posterior compartment position or in PFDI scores. Laparoscopic ASC may be better than USLS for correcting anterior-compartment prolapse, with only a minor risk of mesh erosion.
    International Urogynecology Journal 05/2014; DOI:10.1007/s00192-014-2407-9 · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pelvic reconstructive surgery for pelvic organ prolapse includes transvaginal, open, laparoscopic, and robotic-assisted approaches. Laparoscopy has established a significant role in minimally invasive surgery across surgical disciplines. In pelvic surgery, although the vaginal approach may offer the most native route to a minimally invasive technique, advances in gynecologic laparoscopy have reported advantages over traditional routes maintaining safety, efficacy, and high patient satisfaction. Majority of current data is limited to descriptive case series and retrospective data that nonetheless continue to support the laparoscopic approach as a reasonably safe alternative to open and vaginal approaches. Few prospective, clinical trials have compared the safety, efficacy, and cost-effectiveness of various approaches and surgical techniques highlighting challenges in the utility of robotic-assistance and vaginal graft placement. This literature review provides a summary of important historical and current data in regards to surgical technique and clinical outcomes of advanced pelvic laparoscopy for pelvic organ prolapse.
    09/2013; DOI:10.1007/s13669-013-0050-y
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim was to review the safety and efficacy of pelvic organ prolapse surgery for vaginal apical prolapse. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials (RCT) or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence‟ from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Abdominal sacral colpopexy (ASC) has a higher success rate than sacrospinous colpopexy with less SUI and postoperative dyspareunia for vault prolapse. ASC had greater morbidity including operating time, inpatient stay, slower return to activities of daily living and higher cost (grade A). ASC has the lowest inpatient costs compared with laparoscopic sacral colpopexy (LSC) and robotic sacral colpopexy (RSC). LSC has lower inpatient costs than RSC (grade B).In single RCTs the RSC had longer operating time than both ASC and LSC (grade B). In small trials objective outcomes appear similar although postoperative pain was greater in RSC. LSC is as effective as ASC with reduced blood loss and admission time (grade C). The data relating to operating time are conflicting. ASC performed with polypropylene mesh has superior outcomes to fascia lata (level I), porcine dermis and small intestine submucosa (level 3; grade B). In a single RCT, LSC had a superior objective and subjective success rate and lower reoperation rate compared with polypropylene transvaginal mesh for vault prolapse (grade B).Level 3 evidence suggests that vaginal uterosacral ligament suspension, McCall culdoplasty, iliococcygeus fixation and colpocleisis are relatively safe and effective interventions (grade C). Sacral colpopexy is an effective procedure for vault prolapse and further data are required on the route of performance and efficacy of this surgery for uterine prolapse. Polypropylene mesh is the preferred graft at ASC. Vaginal procedures for vault prolapse are well described and are suitable alternatives for those not suitable for sacral colpopexy.
    International Urogynecology Journal 11/2013; 24(11):1815-33. DOI:10.1007/s00192-013-2172-1 · 2.16 Impact Factor

Full-text (2 Sources)

Download
57 Downloads
Available from
Jun 5, 2014