Name: Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy
Uploaded: 2024-10-25T14:20:00
Description: Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for ...

We thank each participant and staff for their assistance in this study. Special thanks to Hong L for her assistance in figure editing.

The Institutional Review Board of the hospital approved the protocol (IRB Approval Number 2021-040). Informed consent for publication was obtained from each participant. Inclusion criteria encompassed women diagnosed with uterine prolapse at Pelvic Organ Prolapse Quantification (POP-Q) stage 2 or higher with related symptoms who were eligible for surgical treatments and were able to read Chinese. Assessment for eligibility was performed by a gynecologist at the hospital. All patients had a standardized preoperative POP a...

Uterine-Preserving Laparoscopic Cerclage Pectopexy 

<ol>
	<li>Subak, L. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost+of+pelvic+organ+prolapse+surgery+in+the+United+States.">Cost of pelvic organ prolapse surgery in the United States.</a> Obstet Gynecol. 98 (4), 646-651 (2001).</li><li>Seisen, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+obtained+after+robotic-assisted+laparoscopic+sacral+colpopexy+for+the+management+of+urogenital+prolapse:+a+review.">Results obtained after robotic-assisted laparoscopic sacral colpopexy for the management of urogenital prolapse: a review.</a> Prog Urol. 22 (3), 146-153 (2012).</li><li>Maher, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+women+with+apical+vaginal+prolapse.">Surgery for women with apical vaginal prolapse.</a> Cochrane Database Syst Rev. 10 (10), CD012376 (2016).</li><li>No&#233;, K. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+pectopexy:+a+prospective,+randomized,+comparative+clinical+trial+of+standard+laparoscopic+sacral+colpocervicopexy+with+the+new+laparoscopic+pectopexy-postoperative+results+and+intermediate-term+follow-up+in+a+pilot+study.">Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study.</a> J Endourol. 29 (2), 210-215 (2015).</li><li>Maher, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+women+with+apical+vaginal+prolapse.">Surgery for women with apical vaginal prolapse.</a> Cochrane Database Syst. Rev. 7 (7), CD012376 (2023).</li><li>Zhang, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+non-mesh+cerclage+pectopexy+for+pelvic+organ+prolapse.">Laparoscopic non-mesh cerclage pectopexy for pelvic organ prolapse.</a> J Vis Exp. (187), e64388 (2022).</li><li>Korbly, N. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+preferences+for+uterine+preservation+and+hysterectomy+in+women+with+pelvic+organ+prolapse.">Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.</a> Am J Obstet Gynecol. 209 (5), 470.e1-470.e6 (2013).</li><li>Meriwether, K. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uterine+preservation+vs+hysterectomy+in+pelvic+organ+prolapse+surgery:+a+systematic+review+with+meta-analysis+and+clinical+practice+guidelines.">Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines.</a> Am J Obstet Gynecol. 219 (2), 129-146.e2 (2018).</li><li>Zeng, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Introduction+of+intracapsular+rotary-cut+procedures+(IRCP):+A+modified+hysteromyomectomy+procedures+facilitating+fertility+preservation.">Introduction of intracapsular rotary-cut procedures (IRCP): A modified hysteromyomectomy procedures facilitating fertility preservation.</a> J Vis Exp. (143), e58410 (2019).</li><li>Srikrishna, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+Patient+Global+Impression+of+Improvement+(PGI-I)+for+urogenital+prolapse.">Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse.</a> Int Urogynecol J. 21 (5), 523-528 (2010).</li><li>Occhino, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+visual+analog+scale+form+of+the+pelvic+organ+prolapse/urinary+incontinence+sexual+function+questionnaire.">Validation of a visual analog scale form of the pelvic organ prolapse/urinary incontinence sexual function questionnaire.</a> Female Pelvic Med ReconstrSurg. 17 (5), 246-248 (2011).</li><li>Barber, M. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pelvic+floor+disorders+network.+Defining+success+after+surgery+for+pelvic+organ+prolapse.">Pelvic floor disorders network. Defining success after surgery for pelvic organ prolapse.</a> Obstet Gynecol. 114 (3), 600-609 (2010).</li><li>Smith, F. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lifetime+risk+of+undergoing+surgery+for+pelvic+organ+prolapse.">Lifetime risk of undergoing surgery for pelvic organ prolapse.</a> Obstet Gynecol. 116 (5), 1096-1100 (2010).</li><li>Sarlos, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+sacrocolpopexy+for+uterine+and+post-hysterectomy+prolapse:+anatomical+results,+quality+of+life+and+perioperative+outcome-a+prospective+study+with+101+cases.">Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases.</a> Int Urogynecol J Pelvic Floor Dysfunct. 19 (10), 1415-1422 (2008).</li><li>Banerjee, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=a+new+technique+of+prolapse+surgery+for+obese+patients.">a new technique of prolapse surgery for obese patients.</a> Arch Gynecol Obstet. 284 (3), 631-635 (2011).</li><li>Szymczak, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+laparoscopic+techniques+for+apical+organ+prolapse+repair+-+a+systematic+review+of+the+literature.">Comparison of laparoscopic techniques for apical organ prolapse repair - a systematic review of the literature.</a> Neurourol Urodyn. 38 (8), 2031-2050 (2019).</li><li>Obut, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+quality+of+life+and+female+sexual+function+following+laparoscopic+pectopexy+and+laparoscopic+sacrohysteropexy+in+apical+prolapse+patients.">Comparison of the quality of life and female sexual function following laparoscopic pectopexy and laparoscopic sacrohysteropexy in apical prolapse patients.</a> Gynecol Minim Invasive Ther. 10 (2), 96-103 (2021).</li><li>Chan, C. Y. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+the+surgical+management+of+apical+pelvic+organ+prolapse.">A systematic review of the surgical management of apical pelvic organ prolapse.</a> Int Urogynecol J. 34 (4), 825-841 (2023).</li><li>Anglim, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+do+patients+and+surgeons+decide+on+uterine+preservation+or+hysterectomy+in+apical+prolapse.">How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse.</a> Int Urogynecol J. 29 (8), 1075-1079 (2018).</li><li>Kostov, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corona+mortis,+aberrant+obturator+vessels,+accessory+obturator+vessels:+clinical+applications+in+gynecology.">Corona mortis, aberrant obturator vessels, accessory obturator vessels: clinical applications in gynecology.</a> Folia Morphol (Warsz). 80 (4), 776-785 (2021).</li></ol>

A significant number of elderly women worldwide experience Pelvic Organ Prolapse (POP), which involves the descent of at least one pelvic organ. As society ages, the demand for POP surgery is expected to rise dramatically13. Laparoscopic Sacrocolpopexy (LS) is the primary surgical technique for addressing apical prolapse. However, the high incidence of postoperative defecation problems associated with LS cannot be overlooked14. Laparoscopic Pectopexy (LP)&#160; an alternati...

Pelvic organ prolapse (POP) significantly impacts the well-being of a substantial portion of parous women over 50 years old1. With an increasing average lifespan, a higher number of women will require POP surgery. The gold standard for treating uterine prolapse is laparoscopic sacrocolpopexy (LS), in which the vaginal apex is attached to the sacrum over the third and fourth sacral vertebrae using mesh, boasting a success rate exceeding 95% and long-term durability2. However, LS is a challenging procedure commonly associated with postoperative defecation problems3. Additionally, LS may not be suitable for obese patients. Laparoscopic pectopexy (LP), in which the iliopectineal ligaments are used for a bilateral mesh fixation of vaginal vault or cervical stump, has emerged as a viable alternative to LS for addressing apical prolapse, due to comparable clinical efficacy and a lower incidence of defecation disorders4.
However, the usage of synthetic mesh for apical support in LS and LP causes mesh-related complications, increasing patient suffering and medical expenses5. Our team has published a new procedure called laparoscopic non-mesh cerclage pectopexy (LNMCP), embedding permanent cervical cerclage sutures in the round ligament until the iliopectineal ligament. This was successfully performed with high objective and subjective success rates6. Recent evidence suggests that many women with prolapse issues desire to preserve their uterus, which is paramount for maintaining self-confidence, self-esteem, and a sense of femininity7.
The current research reports the development of a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation for POP (LNMCPUP) for addressing apical prolapse. This novel technique involves embedding cervical cerclage sutures in the round ligament until the iliopectineal ligament, resulting in a firm uterine suspension. In addition, without using synthetic mesh, this procedure obviates mesh erosion while reducing medical costs. Moreover, this procedure ensures that the uterus is preserved, thereby minimizing perioperative risks associated with hysterectomy and eliminating significant alterations in POP surgery outcomes8.

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	<tbody>
		<tr>
			<td>5 mm trocars</td>
			<td>KARL STORZ, Germany</td>
			<td>30160X</td>
			<td>Endoscopic equipment</td>
		</tr>
		<tr>
			<td>10 mm trocars&#160;</td>
			<td>KARL STORZ, Germany</td>
			<td>30160 H2</td>
			<td>Endoscopic equipment</td>
		</tr>
		<tr>
			<td>Cefuroxime sodium for injection&#160;</td>
			<td>YOUCARE , China</td>
			<td>H20063758</td>
			<td>Prophylactic antibiotics</td>
		</tr>
		<tr>
			<td>Enoxaparin sodium for injection&#160;</td>
			<td>TECHDOW , China</td>
			<td>H20056847</td>
			<td>Perioperative thrombosis prophylaxis</td>
		</tr>
		<tr>
			<td>Ethibond size 2</td>
			<td>ETHICON, USA</td>
			<td>X519H&#160;</td>
			<td>Nonabsorbable braided polyester</td>
		</tr>
		<tr>
			<td>VICRYL 2-0</td>
			<td>ETHICON, USA</td>
			<td>VCP317H</td>
			<td>Absorbable braided suture</td>
		</tr>
	</tbody>
</table>

laparoscopic non-mesh cerclage pectopexy with uterine preservation for pelvic organ prolapse

Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for treating POP. Recent research has increasingly validated the efficacy and safety of laparoscopic pectopexy (LP) for addressing apical POP. However, the cost of synthetic mesh and associated complications restrict the widespread use of this technique. Our team previously published a study describing a novel, non-mesh procedure called laparoscopic non-mesh cerclage pectopexy (LNMCP), demonstrating successful outcomes with satisfactory objective and subjective success rates. Many patients express a preference for retaining their uterus during prolapse surgery due to considerations related to sexuality, partnership, and body image. 
The present research introduces a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation (LNMCPUP) for POP, wherein the uterus is suspended to the iliopectineal ligament through the round ligament using permanent cerclage sutures. We successfully performed this procedure in 14 cases at our hospital, six of whom still had menstruation, and the remaining eight were postmenopausal, with a mean operation time of 54.43 min (&plusmn; 10.18 min) and an average bleeding volume of 53.57 mL (&plusmn; 48.77 mL). The mean follow-up duration was 19.71 &plusmn; 15.87 months. The objective success rate of LNMCPUP was 100%, with a subjective success rate of 92.86%. No significant complications were observed during or after surgery. LNMCPUP integrates cervical cerclage and shortening of the round ligament, as well as LP without using mesh, thereby eliminating the risk of mesh erosion and lowering healthcare costs. Moreover, this novel technique is relatively easy to master, making it accessible even in rural and underdeveloped areas where synthetic mesh is unavailable. Therefore, it is worthwhile to adopt LNMCPUP in POP patients who desire the preservation of their uterus.

Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy

Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse

A laparoscopic non-mesh cerclage pectopexy with a uterine preservation is developed to treat poor patients who wish to preserve their uterus, which eliminate mesh, lowering complications. The usage of synthetic mesh for IPL support in PUP surgery caused mesh-related complications, increasing patient suffering and medical expenses. LMCPUP integrates cervical cerclage and laparoscopic pectopexy without using mesh, resulting in a form new chain suspect, while also eliminating the risk of mesh erosion and lowering healthcare costs.

We successfully performed Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation (LNMCPUP) in 14 patients over the past 2 years, six of whom were premenopausal, and the remaining eight were postmenopausal. Their average &#177; Standard deviation (SD) age was 52.93 &#177; 9.94 years, with a mean &#177; SD Body mass index (BMI) of 23.46 &#177; 1.95. The average &#177; SD bleeding volume during surgery was 53.57 &#177; 48.77 mL, and the mean &#177; SD operation time was 54.43 &#177; 10.18 min. T...

Here we introduce a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation for pelvic organ prolapse (LNMCPUP) for patients who wish to preserve their uterus. Permanent cerclage sutures are used to suspend the uterus to the iliopectineal ligament through the round ligament.

Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for ...

laparoscopic-non-mesh-cerclage-pectopexy-with-uterine-preservation

Research

JoVE Journal

Medicine

Non-Mesh Laparoscopic Pectopexy with Uterine Retention for Pelvic Organ Prolapse

To begin the laparoscopic bilateral Salpingo-Oophorectomy use an electrosurgical tool to coagulate the round ligament and sever it. Open the vesical uterine recursion peritoneum to expose the uterine artery. To perform cervical isthmic cerclage start at the four o'clock position on the right side and proceed counterclockwise.Continue in a circular motion around the cervix until reaching the starting point. Expose the ileal pectineal ligament and make an incision in the peritoneum. Using surgical tools, detach the surrounding soft tissue between the lateral umbilical ligament and the round ligament.Using a permanent suture of size two, suture ligate and attach the round ligament to the cervical isthmus. Embed the permanent suture into the round ligament ending at the ileal pectineal ligament. Insert the stitch through the ileal ligament and confirm suspension without tension.Next, repeat the process on the other side of the pelvis. Finally, perform reperitonealization. The laparoscopic non mesh pectopexy with uterine preservation was performed successfully in 14 patients with an objective success rate of 100%The subjective success rate assessed with the patient global impression was 92.86%No complications were reported during the follow-up period, which had an average duration of approximately 19.71 months.