Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space?

Lizée, D.; Campagna, Giuseppe; Morciano, Andrea; Panico, Giovanni; Ercoli, Alfredo; Gadonneix, P.

doi:10.1002/nau.23106

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…As several authors highlighted (Gadonneix et al, 2004;Lizee et al, 2017), during LSC, the "two meshes technique" is the most appropriate, because the verticalisation of the vaginal axis, caused by the anterior mesh traction, opens the Douglas cul de sac. A simultaneous mesh on the posterior compartment is, then, necessary to prevent the risk of posterior colpocele and to reinforce the rectovaginal closure.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Posterior Vaginal Plication plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse: a Step-by-Step Video- Article

Morciano,

Scambia,

Tinelli

et al. 2023

Facts Views Vis ObGyn

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Background: In 2023, our Centre validated a surgical approach for patients with anterior/apical prolapse associated with severe posterior colpocele, using a laparoscopic posterior vaginal plication (LPP) combined with standard sacral colpopexy (LSC), demonstrating significant benefits in terms of anatomical repair. Objectives: A step-by-step video demonstration of Laparoscopic Posterior Vaginal Plication (LPP) combined with “two-mesh” Sacral Colpopexy (LSC). Materials and Methods: Surgical technique of a LSC with 2 separate meshes is described. Results: This video-article describes, with a step-by-step approach, a combined prosthetic and fascial laparoscopic technique to treat severe posterior colpocele. Conclusions: LPP can be considered a feasible procedure during a standard LSC in patients with concomitant severe posterior prolapse.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Posterior Vaginal Plication plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse: a Step-by-Step Video- Article

Morciano,

Scambia,

Tinelli

et al. 2023

Facts Views Vis ObGyn

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“…The two surgical teams performed all procedures using a standard technique in accordance with previously published experiences 10–13 …”

Section: Methodsmentioning

confidence: 99%

Sacrocolpopexy after sub‐total hysterectomy vs. sacral hysteropexy for advanced urogenital prolapse: A propensity‐matched study

Arcieri

Morlacco

Montebelli

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo compare objective and subjective outcomes of laparoscopic sacral colpopexy with supracervical hysterectomy (L‐SCP) and robotic sacral hysteropexy (R‐SHP).MethodsThis is a multicenter retrospective propensity score matched study. In the period between January 2014 and December 2018, we enrolled 161 patients with apical prolapse stage 2 or above, alone or with multicompartment descensus.ResultsAfter propensity‐match analysis, there were 44 women for each group. Patients of the two groups had similar preoperative characteristics. No difference was found in terms of estimated blood loss, hospital stay, operative time, and intraoperative or postoperative complications. Subjective success rate, 12 months after surgery, was statistically better in the L‐SCP group (P = 0.034): 81.8% and 97.8% women had Patient Global Impression of Improvement scores less than 3, in R‐SHP and L‐SCP, respectively. The objective cure rate was high in both groups without any significant differences in recurrence rate (P = 0.266).ConclusionBoth procedures are safe and effective in pelvic organ prolapse treatment. Patients who no longer desire uterine preservation could be encouraged to consider L‐SCP. R‐SHP is an alternative in women who are strongly motivated to preserve their uterus in the absence of abnormal uterine findings.

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“…With sacral promontory and endopelvic fascia exposed, the previously configured posterior mesh is inserted through 12 mm assistant port and fixed with a nonabsorbable 2/0 Ti-Cron stitch to Levator Ani fascia bilaterally ( Figure 4 ), similar to other authors. 16 The posterior mesh is then fixed to the sacral promontory with a 2/0 Ticron suture, avoiding excessive tension on the mesh. Two main surgical tips should be followed for bowel preservation: (1) careful isolation taking care of the rectal vascularization and (2) the mesh is then sutured distally to the posterior vaginal wall to lift the mesh closer to the vagina, thus avoiding possible interferences with rectal ampulla as shown in Figure 5 .…”

Section: Methodsmentioning

confidence: 99%

Section: Outcomes Assessmentmentioning

confidence: 99%

Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up

Marzi

Morselli

Maida

et al. 2022

Therapeutic Advances in Urology

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Background: Robotic sacrocolpopexy (RSCP) is an established option for the treatment of apical, anterior, and proximal posterior compartment pelvic organ prolapses (POP). However, there is lack of evidence investigating how lower bowel tract symptoms (LBTS) may change after RSCP. Methods: Data from consecutive patients treated with RSCP for stage 3 or higher POP from 2012 to 2019 at a single tertiary referral center with at least 1 year of follow-up were prospectively collected and retrospectively analyzed. RSCP was performed following a standardized technique which always employed both anterior and posterior hand-shaped meshes. Outcomes were collected at follow-up and analyzed. LBTS were evaluated through the Wexner questionnaire. Results: Overall, 114 women underwent RSCP. Eleven were excluded for missing data, whereas 12 had insufficient follow-up. Thus, 91 (79.8%) patients were included in this cohort. Median follow-up was 42 [interquartile range (IQR), 19–62] months. Mean age was 65 ± 10 years. In our series, RSCP was mainly performed for anterior and apical/medium stage 3 POP (in 95.6% of patients). Anatomic success rate of RSCP was 97.8%, with 89 patients with POP stage 0–1 at 12-month follow-up. Two patients (2.2%) experienced POP recurrence and were treated with redo-SCP. No patient experienced clinically significant posterior vaginal wall prolapse after RSCP. When analyzing LBTS, there was no significant change in postoperative total Wexner’s score as compared to the preoperative value ( p > 0.05). However, the manual assistance subscore was statistically significantly lower within the first-year follow-up ( p = 0.04), but it spontaneously improved during the follow-up ( p = 0.12). Conclusion: RSCP with simultaneous placement of both anterior and posterior mesh is safe and successful to treat high-stage POP in carefully selected patients. Of note, LBTS appear unaffected by posterior mesh placement, supporting its routine use to prevent posterior POP recurrence. Larger prospective studies are needed to confirm our results.

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Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space?

Abstract: Uterosacral tension-free fixation of posterior mesh during LSC could be considered a simple procedure and guarantees a more physiological movement of the pelvic organs if compared with promontory suspension.

Cited by 13 publications

References 21 publications

Laparoscopic Posterior Vaginal Plication plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse: a Step-by-Step Video- Article

Laparoscopic Posterior Vaginal Plication plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse: a Step-by-Step Video- Article

Sacrocolpopexy after sub‐total hysterectomy vs. sacral hysteropexy for advanced urogenital prolapse: A propensity‐matched study

Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up

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