Christine Louis-Sylvestre1, Martine Herry. 1. Department of Obstetrics and Gynecology, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014, Paris, France.
Abstract
INTRODUCTION AND HYPOTHESIS: Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse and can be performed laparoscopically. Robotic assistance allows optimal dissection and placement of the prosthesis. We present a video of our technique along with the results on 90 patients. METHODS: We perform a posterior dissection down to the levator muscles and an anterior dissection down to the trigone. The meshes are made of polyester (mersuture®). The posterior mesh is sutured to the levator muscles, to the rectum above the anorectal junction, below the uterosacral ligaments, and to the isthmus/cervix. The anterior mesh is sutured to the vagina and the isthmus/cervix and attached to the promontory with a tension measured through a vaginal exam. RESULTS: We operated on 90 patients. There was an additional procedure in 71 cases (either subtotal hysterectomy, adnexectomy, adhesiolysis, or rectopexy). The mean operative time was 246 min (180-415). Perioperative complications were one vaginal effraction and a case of sigmoidal perforation during an adhesiolysis. Early complications were two cases of bowel hernia through port sites. The mean hospital stay was 3.48 days (2-11). The mean follow-up is 15.6 months (range 1-45). Six patients have a persistent stage II prolapse. We observed no retraction of the prosthesis and no dyspareunia. CONCLUSIONS: With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point.
INTRODUCTION AND HYPOTHESIS: Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse and can be performed laparoscopically. Robotic assistance allows optimal dissection and placement of the prosthesis. We present a video of our technique along with the results on 90 patients. METHODS: We perform a posterior dissection down to the levator muscles and an anterior dissection down to the trigone. The meshes are made of polyester (mersuture®). The posterior mesh is sutured to the levator muscles, to the rectum above the anorectal junction, below the uterosacral ligaments, and to the isthmus/cervix. The anterior mesh is sutured to the vagina and the isthmus/cervix and attached to the promontory with a tension measured through a vaginal exam. RESULTS: We operated on 90 patients. There was an additional procedure in 71 cases (either subtotal hysterectomy, adnexectomy, adhesiolysis, or rectopexy). The mean operative time was 246 min (180-415). Perioperative complications were one vaginal effraction and a case of sigmoidal perforation during an adhesiolysis. Early complications were two cases of bowel hernia through port sites. The mean hospital stay was 3.48 days (2-11). The mean follow-up is 15.6 months (range 1-45). Six patients have a persistent stage II prolapse. We observed no retraction of the prosthesis and no dyspareunia. CONCLUSIONS: With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point.
Authors: Femke van Zanten; Jan J van Iersel; Tim J C Paulides; Paul M Verheijen; Ivo A M J Broeders; Esther C J Consten; Egbert Lenters; Steven E Schraffordt Koops Journal: Int Urogynecol J Date: 2019-06-20 Impact factor: 2.894