Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach

Houlihan, Sara; Kim-Fine, Shunaha; Birch, Colin; Tang, Selphee; Brennand, Erin A.

doi:10.1007/s00192-018-3801-5

Cited by 27 publications

(36 citation statements)

References 22 publications

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“…Occult SUI may be originally obscured by organ prolapse, and de novo SUI may appear after anatomical restoration, which is why studies with a longer follow-up period should be conducted. Postoperative urinary retention has been reported in 13–32% of patients who undergo POP repair [ 11 , 19 – 21 ]. Houlihan et al reported that the rate of postoperative urinary retention was 31% in vaginal USLS patients and 15% in laparoscopic USLS patients [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative urinary retention has been reported in 13–32% of patients who undergo POP repair [ 11 , 19 – 21 ]. Houlihan et al reported that the rate of postoperative urinary retention was 31% in vaginal USLS patients and 15% in laparoscopic USLS patients [ 11 ]. Yune et al conducted a study to identify risk factors for postoperative urinary retention after POP repair and showed that surgical approach, age, parity, preoperative postvoid residual urine, and concomitant transvaginal anterior/posterior repair may be related factors [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Houlihan et al compared uterosacral vault suspension at the time of hysterectomy via a laparoscopic versus vaginal approach. The results showed less ureteral kinking (0 vs. 14%, p = 0.023), urinary retention (15% vs. 31%, p = 0.024), and symptomatic recurrence (24% vs. 41%, p = 0.046) in the laparoscopic group [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Chen

Wang

et al. 2021

BMC Surg

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Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Methods This was a retrospective study of patients with severe prolapse (≥ stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS. Results A total of 35 patients were included. The mean operative duration was 111.7 ± 39.4 min. The mean blood loss was 67.9 ± 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 ± 1.7 versus − 2.9 ± 0.2), Ba (+ 1.9 ± 2.2 versus − 2.9 ± 0.3), C (+ 1.5 ± 2.2 versus − 6.9 ± 0.9), Ap (− 1.4 ± 1.0 versus − 3.0 ± 0.1) and Bp (− 1.1 ± 1.4 versus − 2.9 ± 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 ± 6.7 and 3.2 ± 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 ± 2.3 and 38.3 ± 4.1, respectively (P < 0.05 for both). During 1–13 months of follow-up, there were no cases of severe complications or recurrence. Conclusions vNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Chen

Wang

et al. 2021

BMC Surg

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“…Postoperative urinary retention is a common complication after POP surgery [13]. Houlihan et al reported that the rate was 31% in vaginal USLS and 15% in laparoscopic USLS [14]. In this study, the rate was 2.9%.…”

Section: Discussionmentioning

confidence: 47%

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Uterosacral Ligament Suspension: a Pilot Study of 35 Caseswith Severe Pelvic Organ Prolapse

Chen

Wang

et al. 2021

Preprint

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Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse.Methods This is a retrospective study conducted for patients with severe prolapsed (≥stage 3) who underwent vNOTES USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES USLS.Results A total of 35 patients were included. The mean operative time was 111.7±39.4 minutes. The mean blood loss was 67.9±35.8 ml. Statistically significant differences were observed before and after vNOTES USLS in regard to Aa (+0.6±1.7 versus −2.9±0.2), Ba (+1.9±2.2 versus −2.9±0.3), C (+1.5±2.2 versus -6.9±0.9), Ap (-1.4±1.0 versus −3.0±0.1) and Bp (-1.1±1.4 versus −2.9±0.1) (P < 0.05 for all). The mean pre- and post-operative PFDI-20 score was 19.9±6.7 versus 3.2±5.4, and the PISQ-12 score was 24.8±2.3 versus 38.3±4.1 (P < 0.05 for both). During 1–13 months of follow-up, no severe complications or recurrence.Conclusions vNOTES USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety data. However, a study with a larger number of patients and a longer follow-up period should be conducted.

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“…However, TLH is useful in the following circumstances: When there is the need for bilateral oophorectomy and/or prophylactic bilateral salpingectomies, when dealing with a substantial number of patients with previous laparotomies (29.37%) and therefore the possibility of pelvic adhesions, for cases of pelvic pain and therefore the need for a thorough pelvic examination, and in the case of patients with enlarged uteri (18% of patients had a uterine weight of more than 300 g). The usefulness of the laparoscopic approach to perform a vaginal vault suspension to the uterosacral ligaments following hysterectomy has been shown to be a safer alternative to the vaginal hysterectomy approach, reducing the risk of ureteral injury [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

Roman¹

2021

Cureus

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IntroductionConcerns about surgical complications and the paucity of surgical audits have been named as reasons for the slow implementation of total laparoscopic hysterectomy (TLH) in New Zealand and Australia, despite a majority of gynaecologists who would like to offer this less-invasive approach to their patients. Material and methodsThis study aims to assess the implementation of TLH as the default method of hysterectomy at a private institution in the Waikato region of New Zealand, and to identify factors related to the perioperative complications and to the failure to accomplish the above procedure laparoscopically in an unselected population.We present 1,287 cases collected over fourteen years with an emphasis on demographics, outcomes, indications for surgery, laparoscopic completion of the surgical procedure and perioperative major complications. ResultsOne hundred and fifty patients (11.7%) were nulliparous and 378 patients (29.4%) had a history of the previous laparotomy. The mean theatre time and SD was 144.84 ± 20.48 min; the mean blood loss was 137.24 ± 69 mL; the mean hospital stay was 2.07 ± 0.31 days; the median uterine weight was 177 g and the biggest uterus removed laparoscopically weighed 1,510 g. Twelve cases were converted to laparotomy (0.93%). The uterine weight had a statistically significant association with the conversion rate.The main indications for surgery were menorrhagia and/or recurrent dysmenorrhoea in 662 patients (51.4%) and fibroid uterus in 228 patients (17.7%). Six patients (0.47%) required blood transfusions. There was a total of 74 perioperative complications (5.7%) and 16 major complications (1.24%). BMI and uterine weight had a statistically significant association with major complication rates. Seven patients (0.54%) were reoperated as a result of a complication. ConclusionThe implementation of TLH as default is achievable and is a safe surgical option. BMI and uterine weight are factors associated significantly with major complications or conversion to laparotomy.

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Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach

Cited by 27 publications

References 22 publications

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Uterosacral Ligament Suspension: a Pilot Study of 35 Caseswith Severe Pelvic Organ Prolapse

Implementation of Total Laparoscopic Hysterectomy As the Default Technique and Lessons Learnt

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