Laparoscopic Pectopexy: A Biomechanical Analysis

Abstract

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.

Suturing methods in prolapse surgery: a biomechanical analysis

“…In this regard, there are two studies worth citing in gynecological surgery: Allahdin et al compared the suturing material itself finding that Vicryl is overall the superior material [21]. Sauerwald and Eichler et al conducted a study to compare single suture techniques versus continuous suturing techniques finding that there was no difference between the ultimate load of a single interrupted suture versus a continuous one for the ileopectineal ligament [8]. However, most interestingly in this study, we were able to show that for failure displacement a continuous suture in the anterior longitudinal ligament is superior to a single suture ( Table 2).…”

“…The evaluation procedure for assessing biomechanical parameters in this study has been established in a previous publication [8]. Figure 1 shows the Instron 5565 test frame used in the study.…”

“…These resulted in calculated parameters such as stiffness (N/mm) and load at 2 mm displacement. The latter being considered as fixation failure in biomechanical evaluations since stability may be lost as dehiscence exceeds 2 mm [8,[13][14][15][16][17].…”

“…Despite several innovative and different new developments in laparoscopy, including robotic surgery as well as standard laparoscopic procedures, a major problem remains regarding the point of fixation as well as the manner of suture placement [4][5][6][7]. In a previous biomechanical analysis, we evaluated the value of combining several sutures compared to a single suture with or without artificial mesh interpolation at the ileo-pectineal ligament [8]. Our results demonstrated that a single suture may be sufficient for adequate suspension.…”

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

“…However, the operation field of pectopexy is surrounded by external iliac vessels and the obturator nerve. Furthermore, fixation to the iliopectineal ligaments of the mesh is non-adjustable, either with single interrupted sutures or continuous sutures 18 .…”