Laparoscopic sacral colpopexy and other procedures for prolapse.

The repair of pelvic support defects is a demanding task. Irrespective of the route or repair chosen by the surgeon, sound surgical judgement, complete understanding of pelvic anatomy and the mechanisms involved in pelvic organ prolapse, and expertise in pelvic surgery are required if successful outcomes are to be expected. Laparoscopic surgery offers a substitute for conventional open abdominal surgery which, in our hospital, now has a record of low complication rates, speedy discharge and recovery times with outcomes that are equal to those achieved by conventional abdominal surgery. This type of surgery is no more difficult to perform than open abdominal surgery. However, it demands the same rigorous training and a very significant amount of time and dedicated effort to learn. The pelvic surgeon who desires to practise this form of advanced laparoscopic surgery must accept these facts. Obviously, more cases and long-term follow-up are needed for meaningful statistical analysis. Randomized prospective trials are greatly preferred, however, it is difficult for the laparoscopic surgeon to carry out such studies when the majority of patients are referred specifically for the laparoscopic route. Good sound statistical data are now becoming available concerning some essential components of the procedure such as laparoscopic knot and suture strengths. It seems very reasonable to conclude that, based on early experience with laparoscopic pelvic reconstruction, the future of this approach is bright.