Laparoscopic colposuspension for total vaginal prolapse.

OBJECTIVE: To present and evaluate a new technique of modified translaparoscopic colpopexy for total vaginal prolapse following hysterectomy as an alternative surgical mode of therapy to abdominal sacral suspension or transvaginal sacrospinous ligament vaginal vault suspension. A modest modification (Group II) of this author's initial surgical technique (Group I) and postoperative observations from 1989 to 1996 are presented.
METHODS: Twenty-seven patients with iatrogenic total vaginal prolapse subsequent to hysterectomy enrolled in this clinical study, which was conducted from September 1989 through February 1996. Posteriorly, vaginal apex was suspended to the deep layer of the uterosacral ligaments. The latero-posteriors vaginal cuff was suspended to the cardinal ligaments. Anteriorly, the vaginal vault was approximated to the pubocervical fascia. These procedures were performed in both groups retroperitoneally. Additionally, and only in Group II, retrpubically, at the mid-pelvic level, the pubocervical fascia and lateral superior vaginal sulci were suspended to the tendinous arch and to the fascia covering the muscles of the pelvic sidewall. This additional part of the operation constituted a modification of the initial translaparoscopic colpopexy (Group I).
RESULTS: In Group I, fifteen patients had good outcome of the operation. However, patient number 16 had a recurrent total vaginal vault prolapse within 6 months following the initial laparoscopic colpopexy. Preceding an initial laparoscopic colpopexy, sacrospinous ligament suspension was performed as one of multiple corrective surgeries. This patient was subjected to the modified laparoscopic colpopexy and has been observed for over three years. The vaginal vault remains well suspended in this particular case as well as in all remaining patients in Group II. There were neither intraoperative, immediate, nor delayed postoperative complications in all 27 patients, in both groups.
CONCLUSIONS: (1) When Group I results are compared with Group II results, the new, modified translaparoscopic retroperitoneal-retropubic colpopexy appeared to be a superior technique and very promising, and offers: (a) vaginal cuff suspension by using natural neighbouring genital pelvic structures, (b) reconstruction of pelvic gross/functional anatomy, placement of the vagina adequately in midline position, and alignment of the vagina parallel to the rectum, and re-constitution of proper relationship between the newly suspended vagina and pelvic viscera. (2) It is a safe operation, simple to learn, and easy to execute; however, retroperitoneal-retropubic-mid-pelvis surgical experience as well as advanced operative laparoscopic skill is needed to meet technical demands of the operation.