Laparoscopic bilateral uterosacropexy – advancement of a new surgical technique with uterine preservation and apical restoration in women with symptomatic pelvic organ prolapse

Introduction Symptomatic pelvic organ prolapse (POP) affects many women. If conservative therapies fail, surgery is needed. Patient's preference with regard to uterine preservation must also be taken into account. For the first time, we present a uterus-preserving surgical technique with a bilateral apical suspension in a step-by-step standardized surgical technique with a minimum amount of synthetic material.

Material and Methods Women with symptomatic uterine prolapse were included in this pilot study. Patients have failed conservative management. Both uterosacralligaments were replaced with a tape-like structure (polyvinylindene-fluoride, PVDF). These tapes of defined length (9cm) and width (0.4cm) were retroperitoneally implanted within the run of both uterosacralligaments under preservation of the peritoneum by using a semi-circular tunneler.

Results Apical support was restored in all 15 patients (mean age: 41 years), as well as urinary continence. No intraoperative complications occurred. Blood loss was less than 30 mL per patient, mean operation time was 56 minutes. Over a mean follow-up period of 20 months, no mesh erosions or relapse of apical prolapse was detected. One patient became pregnant and was delivered by cesarean section in the 39th week without complications.

Conclusion This laparoscopic bilateral uterosacropexy represents one alternative treatment option for uterus-preserving standardized apical reconstruction in premenopausal patients with a minimum amount of synthetic mesh. Further studies need to provide long-term data on anatomic recurrence, and in the case of subsequent pregnancy, especially on the risk of intrapartum complications as well as postpartum anatomic recurrence.

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Artikel online veröffentlicht:
11. Oktober 2022