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

Summary

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.

Abstract

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 (± 10.18 min) and an average bleeding volume of 53.57 mL (± 48.77 mL). The mean follow-up duration was 19.71 ± 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.

Introduction

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 suita....

Protocol

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.......

Discussion

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)  an alternati.......

Materials

Name	Company	Catalog Number	Comments
5 mm trocars	KARL STORZ, Germany	30160X	Endoscopic equipment
10 mm trocars	KARL STORZ, Germany	30160 H2	Endoscopic equipment
Cefuroxime sodium for injection	YOUCARE , China	H20063758	Prophylactic antibiotics
Enoxaparin sodium for injection	TECHDOW , China	H20056847	Perioperative thrombosis prophylaxis
Ethibond size 2	ETHICON, USA	X519H	Nonabsorbable braided polyester
VICRYL 2-0	ETHICON, USA	VCP317H	Absorbable braided suture