A randomized trial of vaginal mesh attachment techniques for minimally invasive sacrocolpopexy

Abstract

The barbed suture technique was 11 - 16 min faster for attaching mesh to the vagina than the non-barbed suture technique. Anatomic outcomes at 12 months were comparable between the suture groups. It is reasonable to use a running, barbed suture in minimally invasive sacrocolpopexy.

Does sacrocolpopexy present heterogeneity in its surgical technique? A systematic review

“…In most included studies—12/22—the preferred mesh material was polypropylene . Mersilene, PTFE, and PVDF meshes were used by one included study, each.…”

“…Mesh shape configuration was poorly described in most studies, with 12/22 studies not giving any description of how the mesh was cut and attached to the vaginal walls. A single piece with a Y configuration was used in three studies . A dual‐piece mesh, with an anterior and a posterior mesh arm, was the preferred configuration among the studies that described this technical step, being used in six studies .…”

“…[12][13][14][15][16] In two studies, the surgeries were all performed by urogynecology fellows, under the supervision of a consultant urogynecologist. 11,17 In all the other 15 studies, surgeons were described as highly experienced or senior surgeons. The total number of surgeons performing the procedures in each study was only informed in three studies [18][19][20] and varied between 2 19 and 31 surgeons.…”

“…There was a significant heterogeneity in this step; a systematic complete dissection, involving both the anterior wall up to the bladder neck and the posterior wall up to the levators or the perineum, was explicitly described in only five studies. 10,11,17,19,24 One study dissected at least 1/3 of the vaginal length, 22 while another considered a minimum of 2/3. 12 In one study, only a deep anterior dissection was described, leaving the posterior dissection at the surgeon's discretion 18 ; in another, only a deep posterior dissection was performed, while the anterior wall had an unspecified extent of separation from the bladder.…”

“…10,18,22,28 Four studies used only tackers or staples for sacral attachment, 17,19,20,23 and another three studies used either tackers/staples or non-absorbable sutures, at the discretion of the surgeon. 9,11,30 3.10 | Type and shape of mesh used…”