V2-09: Laparoscopic cervicosacropexy and vaginosacropexy techniques as treatment of pelvic organ prolapse and urinary incontinence
In the presence of genital prolapse with apical descent, sacrocolpopexy and vaginal sacrospinous fixation are current available procedures. They focus on restoring apical support usually with a piece of mesh made of different materials, undefined length and shape and different fixation sides in the small pelvis. Thereby, non-physiological fixation of cervix/vagina and bladder may result and may be followed by urinary incontinence. _x000D_ Following DeLancey and Ulmsten, we developed a bilateral replacement of the uterosacral ligament (USLs) which are the physiological holding structures. _x000D_ In this study we describe the laparoscopic cervicosacropexy (LACESA) and vaginosacropexy (LAVASA) techniques in the treatment of genital prolapse with apical descent and urinary incontinence. _x000D_
The laparoscopic LACESA) and LAVASA techniques involves substituting both damaged USLs with purpose designed (identical in length and shape) PVDF-structures (polyvinylidene fluoride)._x000D_ The anterior fixation area of the PVDF-structure was centrally placed on the vault / cervical stump with 3 non-absorbable sutures. _x000D_ After identification of the L5-S1, the peritoneum was horizontally blunt dissected and the prevertebral fascial layer of S1/S2 sacral vertebra was prepared. _x000D_ The anatomical path of each USL was tunnelled and the ligament augmentation part of the PVDF-structure was placed. Using a fixation device, the PVDF-structure was attached to the lateral margin of the right and left prevertebral fascial layer of the S1/S2 sacral vertebra with 3 titanium helices on each side._x000D_
We report 94 women who underwent the laparoscopic CESA or VASA procedure for apical descent with a medium follow-up of 18 months. Mean age was 68 years. Preoperative, 67 women had POP-Q stage II, 21 women POP-Q stage III and 6 women POP-Q stage IV. Average operating time was 107 minutes (47 - 129 min.). 69 women had coexisting urinary incontinence (UI). No major intraoperative complications were noted except a bladder lesion and one relapse of prolapse. Within follow-up no mesh erosions were noted. Postoperative, all women had POP-Q stage 0. A 74% continence rate for urinary incontinence was noted.
The LACESA and LAVASA techniques yielded excellent anatomical correction of prolapse. The mesh used is made of PVDF, which cause milder tissue reaction and minimizing the risk of mesh shrinkage/erosions. The unique design of the PVDF structure allows restoration of the USLs with clearly defined surgical steps, making the procedure standardised and reproducible.