Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

Alkatout, İbrahim; Mettler, Liselotte; Peters, Goentje; Noé, Günter K.; Holthaus, Bernd; Jonat, W.; Schollmeyer, Thoralf

doi:10.4293/108680813x13693422520846

Cited by 13 publications

(11 citation statements)

References 33 publications

(35 reference statements)

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“…However, laparoscopic sacrocolpopexy and robot-assisted sacrocolpopexy offer, although more cost and time consuming, effective alternatives [ 4 , 6 ]. In cases where it is difficult to reach the os sacrum however, a pectopexy has also been discussed as a useful and very effective option in recent literature [ 1 , 7 – 9 ]. The use of the ileo-pectineal ligament for a tension free mesh suspension is not a new concept and has been used by other groups [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Literature describes the exact pectopexy fixation method of the transverse mesh as being performed with 2 separate stitches on the ileo-pectineal ligament with nonabsorbable sutures (No. 0 with attached needle) [ 7 ]. Noe et al generally uses two single “interrupted” sutures or, in case of a colposuspension, a “continuous” type suture.…”

Section: Introductionmentioning

confidence: 99%

“…Noe et al generally uses two single “interrupted” sutures or, in case of a colposuspension, a “continuous” type suture. While most of the surgical steps as described by Banerjee et al [ 1 ] and Alkatout et al [ 7 ] may not be eliminated, surgical time may only be optimized by omitting unnecessary procedures. Since laparoscopic continuous suturing is time-consuming we hypothesized that a single suture may also be sufficient.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Pectopexy: A Biomechanical Analysis

et al. 2016

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IntroductionPectopexy, a laparoscopic method for prolapse surgery, showed promising results in recent literature. Further improving this approach by reducing surgical time may decrease complication rates and patient morbidity. Since laparoscopic suturing is a time consuming task, we propose a single suture /mesh ileo-pectineal ligament fixation as opposed to the commonly used continues approach.MethodsEvaluation was performed on human non-embalmed, fresh cadaver pelves. A total of 33 trials was performed. Eight female pelves with an average age of 75, were used. This resulted in 16 available ligaments. Recorded parameters were ultimate load, displacement at failure and stiffness.ResultsThe ultimate load for the mesh + simplified single “interrupted” suture (MIS) group was 35 (± 12) N and 48 (± 7) N for the mesh + continuous suture (MCS) group. There was no significant difference in the ultimate load between both groups (p> 0.05). This was also true for displacement at failure measured at 37 (± 12) mm and 36 (±5) mm respectively. There was also no significant difference in stiffness and failure modes.ConclusionGiven the data above we must conclude that a continuous suture is not necessary in laparoscopic mesh / ileo-pectineal ligament fixation during pectopexy. Ultimate load and displacement at failure results clearly indicate that a single suture is not inferior to a continuous approach. The use of two single sutures may improve ligamental fixation. However, overall stability should not benefit since the surgical mesh remains the limiting factor.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Pectopexy: A Biomechanical Analysis

et al. 2016

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“…Generally, hysterectomy is considered to be the traditional surgical approach for gynecological diseases . However, hysterectomy is associated with the destruction of the integrity and continuity of supportive tissues, including the pubocervical and rectovaginal fascias, resulting in recurrent prolapse . It is reported that vaginal vault prolapse following hysterectomy may occur in approximately 0.5 to 6.52% of patients .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse

Dai

Shu

2019

J of Obstet and Gynaecol

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Aim: To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse. Methods: A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra-and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively. Results: The mean surgical time was 130.4 (82-190) min, the average blood loss was 50.4 (10-300) mL and the mean hospitalization was 5.3 (4-8) days. The rates of intra-and postoperative complications were low. After a minimal of 12 months follow-up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse. Conclusion: LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse.

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“…Furthermore, a clear operating field permits accurate assessment of the use of electricity and thermal spread in a radical procedure. This is especially important when operating close to the bowel, ureter, major vessels, or nerves in the pelvis, the mid-abdomen, or the upper abdomen [1]. A clear field of view is mandatory for all advanced endoscopic procedures based on conventional laparoscopy or robotic-assisted surgery in gynecology, urology, or visceral surgery.…”

Section: Introductionmentioning

confidence: 99%

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

Alkatout

2018

Minimally Invasive Therapy & Allied Technologies

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Background: The removal of obstacles from the surgical field is a crucial aspect of any procedure in gynecological, urological or visceral laparoscopic surgery. Reliable instruments and skilled assistance are essential for the smooth execution of procedures. Blunt forceps are commonly used to keep tissue away from the operating field. The range of existing instruments has been enhanced by the introduction of laparoscopic retractors. However, no laparoscopic retractor can be used without causing tissue damage. Material and methods: We describe the ALKATOUT retractor, an innovative laparoscopic retractor designed for atraumatic assistance in any laparoscopic procedure including robotic surgery. The advantages of this laparoscopic instrument were evaluated in a single-center study. Results: The retractor has been used successfully in a variety of gynecological procedures and tested in laparoscopic procedures on human body donors. Conclusions:The results of a single-center questionnaire completed by 25 operating room staff (surgical nurses, residents, and specialists) confirm the advantages of the ALKATOUT retractor.

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Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

Abstract: Several key steps essential for the reduction of vaginal prolapse in patients undergoing laparoscopic hysterectomy are reported.

Cited by 13 publications

References 33 publications

Laparoscopic Pectopexy: A Biomechanical Analysis

Laparoscopic Pectopexy: A Biomechanical Analysis

Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

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