Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

Kale, Ahmet; Biler, Alper; Terzi, Hasan; Usta, Taner; Kale, Ebru

doi:10.1590/s1677-5538.ibju.2017.0070

Cited by 32 publications

(24 citation statements)

References 23 publications

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“…Pelvic organ prolapse (POP) is a worldwide health problem, the prevalence of which ranges from 10% in younger women to 50% in postmenopausal women. Apical defect, the least frequent of all POP types, has been reported in 5%‐15% of women . DeLancey established three levels of support for proper position of the pelvic organs: Level I: uterosacral ligaments (damage: uterine/vaginal vault prolapse, enterocoele); Level II: pubocervical and rectovaginal fascia (damage: cystocele, rectocele); Level III: perineal membrane and perineal body (damage: urethrocele, perineal body defect/excessive perineal descent) …”

Section: Introductionmentioning

confidence: 99%

“…Pubocervical ligaments attach to the anterior, cardinal ligaments to the lateral, and uterosacral ligaments to the posterior parts of the pericervical ring. Damage to these structures results in clinical uterine prolapse or enterocoele …”

Section: Introductionmentioning

confidence: 99%

“…Damage to these structures results in clinical uterine prolapse or enterocoele. 2 Apical support is the keystone of female pelvic organ support. 10 Stage ≥ II anterior prolapse is highly suggestive of clinically significant apical descent.…”

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confidence: 99%

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Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Szymczak

Grzybowska

Wydra

2019

Neurourology and Urodynamics

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Aims Apical defect is a pelvic organ prolapse disorder, with 5%‐15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). Methods A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. Results A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP‐Q < II stage) was 77%‐100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%‐97.6%, 71.0%‐100%, 66.7%‐87.8%, and 95%‐95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%‐12.8%. Conclusions Most studies reported anatomical and subjective outcomes, with follow‐up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Szymczak

Grzybowska

Wydra

2019

Neurourology and Urodynamics

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“…Because of the close anatomical structures which are present at the operation field; small intestines, sigmoid colon, ureter and presacral vessels are in risk of injury. Kale et al (14) conducted a case series study and applied pectopexy to seven patients with apical prolapse and reported no intraoperative and postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

“…During the pectopexy surgery, the pectineal ligament represents a distant space from the intestines, sigmoid colon, presacral vessels, and ureter, thus they stated that the pectineal ligament maintains a safe surgical field in pectopexy surgery. Moreover, Kale et al (14) offered this technique as a feasible procedure because the surgeon uses a wide area in the pelvis and the strong nature of pectineal ligament would decrease the postoperative recurrence rates. Our study did not demonstrate the exact anatomic distance to these structures; however, our anatomic dissections revealed that the small intestines and sigmoid colon were far away from the operation field unless an adhesion was detected.…”

Section: Discussionmentioning

confidence: 99%

Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures

Pulatoğlu¹,

Doğan²,

Medisoğlu³

et al. 2020

tjod

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Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to the right obturator canal it was 3.57±0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.

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Meta‐analysis of the comparison of laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse

Xiao,

Du,

Geng

et al. 2024

Intl J Gynecology & Obste

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BackgroundThe effectiveness and safety of laparoscopic pectopexy (LP) in the treatment of female pelvic organ prolapse (POP) have recently gained significant interest.ObjectiveThis study aimed to compare the outcomes and effectiveness of LP and laparoscopic sacrocolpopexy (LSC).Search StrategyA comprehensive literature search was conducted across multiple databases, including PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Clinical Trials, and CNKI. No language restrictions were applied in the search. The search encompassed the entire period from the inception of the respective databases to April 2023.Selection Criteria and Data CollectionAll randomized controlled trials and comparative studies were included. A cumulative analysis was conducted on 10 studies, accounting for 15% of the overall research pool. The sample sizes of these studies were 760. Two researchers independently evaluated the eligibility of the studies, collected the relevant data, and evaluated their potential bias.Main ResultsCompared with LSC, the average operation time for LP in the simple surgery group was shorter (standardized mean difference [SMD] –2.14, 95% CI –2.68 to −1.60, P < 0.001). The average bleeding volume was lower (SMD –3.17, 95% CI –5.22 to −1.12, P = 0.002), the postoperative indwelling catheterization time was shorter (SMD –0.35, 95% CI –0.67 to −0.02, P = 0.040), and there were fewer total postoperative complications (odds ratio [OR] 0.53, 95% CI 0.30–0.94, P = 0.030). In terms of effectiveness, the LP group had fewer postoperative prolapse recurrences than the LSC group (OR 0.33, 95% CI 0.14–0.77, P = 0.010).ConclusionLP demonstrates a comparable surgical efficacy to LSC. However, the surgical safety of LP is significantly improved. These findings should be validated by including additional randomized controlled trials.

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Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

Cited by 32 publications

References 23 publications

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

Surgical anatomy of the pectineal ligament during pectopexy surgery: The relevance to the major vascular structures

Meta‐analysis of the comparison of laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse

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