A computational study of organ relocation after laparoscopic pectopexy to repair posthysterectomy vaginal vault prolapse

Bhattarai, Aroj; Staat, Manfred

doi:10.1080/21681163.2019.1670095

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…35 The surgical meshes (A and B) used in our study presented a lower stiffness when compared to the Gynemesh ® mesh. The maximum stress for this mesh was approximately 8.0 MPa, 24 while those used in the present study showed the stress of approximately 4.5 MPa for A mesh and 3.5 MPa for B mesh.…”

Section: Discussioncontrasting

confidence: 48%

“…21,22 Computational models were used to evaluate midurethral displacements when its supportive structures are impaired and assess how synthetic slings reduce the displacement of the bladder and bladder neck. 23 Bhattarai and Staat 24 simulated, through computational methods, a laparoscopic pectopexy surgery to repair posthysterectomy vaginal vault prolapse. These authors included implant models in the pelvic cavity model to examine the effectiveness of different commercial mesh implants.…”

Section: Introductionmentioning

confidence: 99%

“…These authors included implant models in the pelvic cavity model to examine the effectiveness of different commercial mesh implants. 24 In addition, computer modeling was also used for surgical planning of sacrocolpopexy. 25 Sacrocolpopexy is minimally invasive and is the gold standard procedure for stage III–IV apical prolapse, a downward displacement of the vaginal apex.…”

Section: Introductionmentioning

confidence: 99%

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Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair

Silva

Bessa

Rynkevic

et al. 2022

Proc Inst Mech Eng H

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Synthetic implants were used for repair of anterior compartment prolapses, which can be caused by direct trauma resulting in damaged pelvic structures. The mechanical properties of these implants may cause complications, namely erosion of the mesh through the vagina. In this study, we evaluated, by modeling, the behavior of implants, during Valsalva maneuver, used to replace damaged uterosacral ligaments (USLs), mimicking a sacrocolpopexy repair. For this purpose, two synthetic implants (A®, for prolapse repair and B®, for Hernia repair) were uniaxially tested, and the mechanical properties obtained were incorporated in the computational models of the implants. The computational model for the implant was incorporated into the model of the female pelvic cavity, in order to mimic the USLs after its total rupture and with 90% and 50% impairment. The total rupture and impairments of the USLs, caused a variation of the supero-inferior displacement and displacement magnitude of the vagina, with higher values for the total rupture. With total rupture of the USLs, when compared to healthy USLs, supero-inferior displacement and displacement magnitude of the vagina increased by 4.98 mm (7.69 mm vs 12.67 mm) and 6.62 mm (9.38 mm vs 16.00 mm), respectively. After implantation (A® and B®) a reduction of the supero-inferior displacements of the anterior vaginal wall occurred, to values found in the case of the model without any impairment or rupture of the ligaments. The simulation was able to mimic the biomechanical response of the USLs, in response to different implants stiffnesses, which can be used in the development of novel meshes.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair

Silva

Bessa

Rynkevic

et al. 2022

Proc Inst Mech Eng H

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“…However, that fact allowed us to observe that LP might additionally have a protective effect on the anterior compartment [13,18] as compared to SSLF, which was confirmed in our study for point Aa. Moreover, in a computer simulation, during the Valsalva maneuver, bilateral fixation in LP allows for better physiological positioning of the vaginal cuff and bladder than unilateral SCP [44]. There is no consensus as to whether bilateral SSLF has an advantage over unilateral SSLF in terms of effectiveness and patient subjective outcome.…”

Section: Discussionmentioning

confidence: 99%

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II–IV Apical Prolapse

Szymczak

Grzybowska

Sawicki

et al. 2022

JCM

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The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.

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“…In this study, 15 cm of PVDF tape (Dynamesh PRP 3 × 15) were used solely for apical support (approximately 25 cm²). In a computer simulation, Bhattarai et al showed that bilateral fixation in pectopexy permits better physiological positioning of the bladder and vaginal cuff than unilateral sacral colpopexy during the Valsalva maneuver [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair

Noé

Schiermeier

Papathemelis

et al. 2021

JCM

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Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy.

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A computational study of organ relocation after laparoscopic pectopexy to repair posthysterectomy vaginal vault prolapse

Cited by 4 publications

References 34 publications

Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair

Simulation of vaginal uterosacral ligament suspension damage, mimicking a mesh-augmented apical prolapse repair

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II–IV Apical Prolapse

Prospective International Multicenter Pelvic Floor Study: Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair

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