Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Cheng-Yu Long, Chiu-Lin Wang, Kun-Ling Lin, Chin-Ru Ker, Zixi Loo, Yiyin Liu, Pei-Chi Wu, Cheng-Yu Long, Chiu-Lin Wang, Kun-Ling Lin, Chin-Ru Ker, Zixi Loo, Yiyin Liu, Pei-Chi Wu

Abstract

We aim to assess the surgical outcomes of our novel hysteropexy procedure, laparoscopic long mesh surgery (LLMS) with augmented round ligaments. Twenty-five consecutive women with stage II or greater main uterine prolapse defined by the POP quantification staging system were referred for LLMS. Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along the bilateral round ligaments. The clinical evaluations performed before and 6 months after surgery included pelvic examinations, urodynamic studies, and questionnaires for urinary and sexual symptoms. After a follow-up time of 12 to 24 months, the anatomical reduction rate was 92% (23/25) for the apical compartment. The average operative time was 65.4 ± 28.8 minutes. No major complications were recognized during LLMS. The lower urinary tract symptoms and scores on the questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was observed after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 15 sexually active women did not differ significantly after LLMS. The results of our study suggest that LLMS is an effective, safe, and time-saving hysteropexy surgery for the treatment of apical prolapse.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
The clinical trial flowchart for laparoscopic long mesh surgery with augmented round ligaments.
Figure 2
Figure 2
The parameters and design of the long mesh.
Figure 3
Figure 3
The procedural process. (A) Under laparoscopy, the peritoneum of the utero-vesical fold was dissected to expose the anterior colpo-cervical junction. T-shaped self-tailored long mesh was delivered to the operation field. Bilateral mesh legs were extracted outside the trocar wounds to stabilize the mesh position. (B) Center piece of the mesh was fixed to the cervix with ProTack screws (Covidien, New Haven, Connecticut), Stratafix 2-0 sutures (Ethicon, Norderstedt, Germany) and Tisseel fibrin sealant (Baxter, Deerfield Illinois). (C) Bilateral round ligaments and the mesh arms were sutured continuously with Stratafix 2-0. (D) Reperitonealization with the remaining Stratafix 2-0 sutures. (E) The tension of the mesh was adjusted until the cervix was reduced to the deepest point according to the vaginal examination.

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