gms | German Medical Science

Introduction: Surgical treatment for pelvic organ prolapse (POP) underwent significant changes in recent years. The traditional vaginal hysterectomy does not address the underlying pathophysiology of poor connective tissue support, which may result in a higher incidence of recurrence. Vaginal meshes that were used extensively were simplified to mesh kits and following the FDA warnings regarding their safety, they have been widely abandoned. A change in practice patterns among urogynecologists has been noted reviving the use of sacropexy.

Abdominal sacropexy is considered the “gold standard” in POP surgery. It is associated with high success rates of over 90% with low recurrence rates. The laparoscopic sacropexy seems to achieve similar success rates in addition to having advantages of less blood loss, reduced morbidity, and shorter hospital stay.

Nevertheless, complications such as new onset bowel, voiding, and sexual dysfunction, de-novo stress incontinence, obstructed defecation syndrome and mesh erosion after sacropexy have been reported and may have a negative effect on patient’s satisfaction.

One of the greatest technical challenges in performing this procedure is creating a sub-peritoneum tunnel for the mesh. Optimizing the procedure in order to obtain better anatomic reconstruction and choosing the material according to its biomechanical characteristics are a challenge that surgeons are faced with in an attempt to minimize mesh-related complications.

Method: From 02/2014 untill 05/2019 we used a novel technique to perform laparoscopic sacropexy for women with POP using a reusable helical tunnelling device and an MRI visible narrow, macroporous monofilament mesh sling with a needle at the end.

Results: 117 women were assessed at a mean follow-up of 4.1 (range, 0.2–0.9) years after laparoscopic sacrocolpopexy, 87% (102/117) of whom considered themselves to be cured or improved, and none had required reoperation. On clinical examination, prolapse recurrence in the apical compartment was not diagnosed in any patient. Dyspareunia or chronic pelvic pain was not diagnosed in 1 patient. The tunneling device reduced the total operation time to 65 min (from 100 min without RTD).

Conclusion: At an average follow-up of 4 years, laparoscopic sacrocolpopexy was highly effective for apical support. This novel procedure shows great promise in the treatment of POP. This procedure apart from having the advantages of a minimal invasive surgery, is easy to learn, easy to perform, has shorter operating time, has a minimal mesh area reducing the risk of erosion and is MRI visible. This new technique may be used for young patients wishing to preserve the uterus as well as for older patients following hysterectomy.

Competing interests: Dr J. Neymeyer was paid for teaching and speaking on behalf of SERAG, AMS and ETHICON. Other authors declare no financial disclosure.