Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse

Abstract

Background and objectives: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation. Materials and Methods: Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi ® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position. Main outcome measures: For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system. Results: Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored. Conclusions: Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair.

Apical prolapse correction by unilateral pectineal suspension

“…Furthermore, preserving the uterus in the absence of uterine pathology has become an appropriate option [ 3 ]. Recently, the method of unilateral pectineal suspension (UPS) was established for uterus-preserving mesh-free apical POP correction [ 4 ]. A retrospective analysis of 47 patients revealed excellent short-term results with a subjective and objective treatment success of 93.6% as defined by a standardized composite endpoint [ 5 ].…”

Total Pelvic Floor Lifting: A New Approach for the Anatomic Repair of Pelvic Floor Hypermobility and Vaginal Laxity in Parous Women

“…UPS is also very suitable for robotic surgery, shortening the operative time. 12 It is noteworthy to mention that the tension-free principle of the UPS concept allows the midline repositioning of the cervix. Correct midline positioning is confirmed intraoperatively by vaginal examination.…”