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Marlies Y Bongers - One of the best experts on this subject based on the ideXlab platform.
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treatment of Vaginal Vault Prolapse in the netherlands a clinical practice survey
International Urogynecology Journal, 2019Co-Authors: Carolien K M Vermeulen, Annelotte W M Coolen, Jan Paul W R Roovers, Wilbert A Spaans, Marlies Y BongersAbstract:A great variety of conservative and surgical procedures to correct Vaginal Vault Prolapse have been reported. The aim of this study was to describe practice pattern variation—the difference in care that cannot be explained by the underlying medical condition—among Dutch gynecologists regarding treatment of Vaginal Vault Prolapse. A clinical practice survey was conducted from March to April 2017. The questionnaire was developed to evaluate treatment of Vaginal Vault Prolapse. All members of the Dutch Society for Urogynaecology were invited to participate in a web-based survey. One hundred four Dutch gynecologists with special interest in urogynecology responded to the survey (response rate, 44%). As first-choice therapy for Vaginal Vault Prolapse, 78% of the respondents chose pessary treatment, whereas sacrospinous fixation was the second most common therapy choice according to 64% of the respondents. Preferences on how to approach Vaginal Vault Prolapse surgically are conflicting. Overall, the most performed surgery for Vaginal Vault Prolapse is sacrospinous fixation, followed by laparoscopic and robotic sacrocolpopexy. Gynecologists in The Netherlands manage Vaginal Vault Prolapse very differently. No standardized method could be determined for the treatment of Vaginal Vault Prolapse in The Netherlands, and we observed practice pattern variations.
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Laparoscopic sacrocolpopexy versus Vaginal sacrospinous fixation for Vaginal Vault Prolapse, a randomized controlled trial: SALTO-2 trial, study protocol
BMC Women's Health, 2017Co-Authors: Annelotte W M Coolen, Ben Willem J Mol, Mèlanie N. Ijsselmuiden, Anique M. J. Oudheusden, J. Veen, Hugo W. F. Eijndhoven, Jan Paul Roovers, Marlies Y BongersAbstract:Background Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of Prolapse symptoms, will visit a gynaecologist for a surgical correction of a Vaginal Vault Prolapse thereafter. Vaginal Vault Prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to Vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for Prolapse of the Vaginal Vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of Vaginal Vault Prolapse. Methods We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, Vaginal Vault Prolapse will be included. Participants will be randomized to the Vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on Prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. Discussion The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or Vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 Vault Prolapse. Trial registration Netherlands Trial Register (NTR): NTR3977 ; Registered 28 April 2013.
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laparoscopic sacrocolpopexy versus Vaginal sacrospinous fixation for Vaginal Vault Prolapse a randomized controlled trial salto 2 trial study protocol
BMC Women's Health, 2017Co-Authors: Annelotte W M Coolen, Anique M J Van Oudheusden, Hugo W F Van Eijndhoven, Ben Willem J Mol, J. Veen, Melanie N Van Ijsselmuiden, Jan Paul W R Roovers, Marlies Y BongersAbstract:Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of Prolapse symptoms, will visit a gynaecologist for a surgical correction of a Vaginal Vault Prolapse thereafter. Vaginal Vault Prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to Vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for Prolapse of the Vaginal Vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of Vaginal Vault Prolapse. We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, Vaginal Vault Prolapse will be included. Participants will be randomized to the Vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on Prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or Vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 Vault Prolapse. Netherlands Trial Register (NTR): NTR3977 ; Registered 28 April 2013.
Annelotte W M Coolen - One of the best experts on this subject based on the ideXlab platform.
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treatment of Vaginal Vault Prolapse in the netherlands a clinical practice survey
International Urogynecology Journal, 2019Co-Authors: Carolien K M Vermeulen, Annelotte W M Coolen, Jan Paul W R Roovers, Wilbert A Spaans, Marlies Y BongersAbstract:A great variety of conservative and surgical procedures to correct Vaginal Vault Prolapse have been reported. The aim of this study was to describe practice pattern variation—the difference in care that cannot be explained by the underlying medical condition—among Dutch gynecologists regarding treatment of Vaginal Vault Prolapse. A clinical practice survey was conducted from March to April 2017. The questionnaire was developed to evaluate treatment of Vaginal Vault Prolapse. All members of the Dutch Society for Urogynaecology were invited to participate in a web-based survey. One hundred four Dutch gynecologists with special interest in urogynecology responded to the survey (response rate, 44%). As first-choice therapy for Vaginal Vault Prolapse, 78% of the respondents chose pessary treatment, whereas sacrospinous fixation was the second most common therapy choice according to 64% of the respondents. Preferences on how to approach Vaginal Vault Prolapse surgically are conflicting. Overall, the most performed surgery for Vaginal Vault Prolapse is sacrospinous fixation, followed by laparoscopic and robotic sacrocolpopexy. Gynecologists in The Netherlands manage Vaginal Vault Prolapse very differently. No standardized method could be determined for the treatment of Vaginal Vault Prolapse in The Netherlands, and we observed practice pattern variations.
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Laparoscopic sacrocolpopexy versus Vaginal sacrospinous fixation for Vaginal Vault Prolapse, a randomized controlled trial: SALTO-2 trial, study protocol
BMC Women's Health, 2017Co-Authors: Annelotte W M Coolen, Ben Willem J Mol, Mèlanie N. Ijsselmuiden, Anique M. J. Oudheusden, J. Veen, Hugo W. F. Eijndhoven, Jan Paul Roovers, Marlies Y BongersAbstract:Background Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of Prolapse symptoms, will visit a gynaecologist for a surgical correction of a Vaginal Vault Prolapse thereafter. Vaginal Vault Prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to Vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for Prolapse of the Vaginal Vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of Vaginal Vault Prolapse. Methods We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, Vaginal Vault Prolapse will be included. Participants will be randomized to the Vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on Prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. Discussion The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or Vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 Vault Prolapse. Trial registration Netherlands Trial Register (NTR): NTR3977 ; Registered 28 April 2013.
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laparoscopic sacrocolpopexy versus Vaginal sacrospinous fixation for Vaginal Vault Prolapse a randomized controlled trial salto 2 trial study protocol
BMC Women's Health, 2017Co-Authors: Annelotte W M Coolen, Anique M J Van Oudheusden, Hugo W F Van Eijndhoven, Ben Willem J Mol, J. Veen, Melanie N Van Ijsselmuiden, Jan Paul W R Roovers, Marlies Y BongersAbstract:Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of Prolapse symptoms, will visit a gynaecologist for a surgical correction of a Vaginal Vault Prolapse thereafter. Vaginal Vault Prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to Vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for Prolapse of the Vaginal Vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the Vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of Vaginal Vault Prolapse. We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, Vaginal Vault Prolapse will be included. Participants will be randomized to the Vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on Prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, post-operative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or Vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 Vault Prolapse. Netherlands Trial Register (NTR): NTR3977 ; Registered 28 April 2013.
George K Chow - One of the best experts on this subject based on the ideXlab platform.
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Assessment of the durability of robot-assisted laparoscopic sacrocolpopexy for treatment of Vaginal Vault Prolapse
Journal of Robotic Surgery, 2007Co-Authors: Daniel S Elliott, Sameer A. Siddiqui, George K ChowAbstract:Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the definitive treatment option for post-hysterectomy Vaginal Vault Prolapse. It is, however, associated with greater morbidity than Vaginal repair. We describe a minimally invasive technique for Vaginal Vault Prolapse repair and present our experience with a minimum of one-year follow-up. The surgical technique involves five laparoscopic ports—three for the da Vinci robot and two for the assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the Vaginal apex by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy Vaginal Vault Prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months follow-up, with a mean follow-up of 36 months (range 12–48) in the group. Mean age was 67 (47–83) years and mean operating time was 3.1 (2.15–4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent Vault Prolapse, and two suffered from Vaginal extrusion of mesh. All patients were satisfied with their outcome. The robot-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for Vaginal Vault Prolapse repair, combining the advantages of open sacrocolpopexy with the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient satisfaction, with a minimum of 1-year follow-up. Most importantly, the long-term results of the robotic repair are similar to those of open repair, but with significantly less morbidity.
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long term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade Vaginal Vault Prolapse
The Journal of Urology, 2006Co-Authors: Daniel S Elliott, Amy E Krambeck, George K ChowAbstract:Purpose: Transabdominal sacrocolpopexy is a definitive treatment option for Vaginal Vault Prolapse with durable success rates. However, it is associated with increased morbidity compared with Vaginal repairs. We describe a minimally invasive technique of Vaginal Vault Prolapse repair and present our experience with a minimum of 1 year followup.Materials and Methods: The surgical technique involves 5 laparoscopic ports: 3 for the da Vinci® robot and 2 for the assistant. A polypropylene mesh is attached to the sacral promontory and Vaginal apex using polytetrafluoroethylene sutures. The mesh material is then covered by peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction and morbidity with a minimum of 12 months followup.Results: A total of 30 patients with post-hysterectomy Vaginal Vault Prolapse underwent robotic assisted laparoscopic sacrocolpopexy at our institution and 21 have a minimum of 12 months followup. Mean followup was 24 months (range 12 to 36) and me...
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gynecologic use of robotically assisted laparoscopy sacrocolpopexy for the treatment of high grade Vaginal Vault Prolapse
American Journal of Surgery, 2004Co-Authors: Daniel S Elliott, Igor Frank, David S Dimarco, George K ChowAbstract:Abstract Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade Vaginal Vault Prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with Vaginal repairs. In this article, we describe a novel minimally invasive technique of Vaginal Vault Prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the Vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic Vaginal Vault Prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1–12) months and mean age was 66 (range, 47–82) years. The mean total operative time was 3.2 (range, 2.25–4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for Vaginal Vault Prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.
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robotic assisted laparoscopic sacrocolpopexy for treatment of Vaginal Vault Prolapse
Urology, 2004Co-Authors: David S Di Marco, George K Chow, Matthew T Gettman, Daniel S ElliottAbstract:Abstract Introduction To describe and demonstrate the use and benefit of robotic-assisted laparoscopic sacrocolpopexy in the treatment of posthysterectomy Vaginal Vault Prolapse. Technical considerations The procedure combines the use of standard laparoscopy with the daVinci robotic system. The patient is placed in the dorsal lithotomy position. One camera port, two robotic ports, and two standard laparoscopic ports are placed transperitoneally. Standard laparoscopic dissection, in combination with an intraVaginal retractor, is used for initial anterior and posterior Vaginal mobilization and exposure of the sacral promontory. The daVinci robot is then docked and used to suture a silicone Y -shaped graft from the vagina to the sacral promontory. Culdoplasty, with plication of the uterosacral ligaments, is then performed, with the final step, retroperitonealization of the graft. Conclusions A total of 5 women have undergone this procedure, 3 with concomitant puboVaginal sling placement. All 5 women were discharged after 24 hours. No complications from the sacrocolpopexy were reported; however, 1 patient experienced transient Vaginal bleeding related to the puboVaginal portion of the case. No recurrent anterior, posterior, or apical Prolapse has occurred at mean of 4 months of follow-up. Using a robotic system for laparoscopic sacrocolpopexy facilitated precise intracorporeal suture placement so that the procedure could be done in a fashion similar to that of the open method. Robotic-assisted laparoscopic sacrocolpopexy may provide the same long-term durability of open sacrocolpopexy with the benefit of a minimally invasive approach.
Daniel S Elliott - One of the best experts on this subject based on the ideXlab platform.
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Assessment of the durability of robot-assisted laparoscopic sacrocolpopexy for treatment of Vaginal Vault Prolapse
Journal of Robotic Surgery, 2007Co-Authors: Daniel S Elliott, Sameer A. Siddiqui, George K ChowAbstract:Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the definitive treatment option for post-hysterectomy Vaginal Vault Prolapse. It is, however, associated with greater morbidity than Vaginal repair. We describe a minimally invasive technique for Vaginal Vault Prolapse repair and present our experience with a minimum of one-year follow-up. The surgical technique involves five laparoscopic ports—three for the da Vinci robot and two for the assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the Vaginal apex by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy Vaginal Vault Prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months follow-up, with a mean follow-up of 36 months (range 12–48) in the group. Mean age was 67 (47–83) years and mean operating time was 3.1 (2.15–4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent Vault Prolapse, and two suffered from Vaginal extrusion of mesh. All patients were satisfied with their outcome. The robot-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for Vaginal Vault Prolapse repair, combining the advantages of open sacrocolpopexy with the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient satisfaction, with a minimum of 1-year follow-up. Most importantly, the long-term results of the robotic repair are similar to those of open repair, but with significantly less morbidity.
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long term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade Vaginal Vault Prolapse
The Journal of Urology, 2006Co-Authors: Daniel S Elliott, Amy E Krambeck, George K ChowAbstract:Purpose: Transabdominal sacrocolpopexy is a definitive treatment option for Vaginal Vault Prolapse with durable success rates. However, it is associated with increased morbidity compared with Vaginal repairs. We describe a minimally invasive technique of Vaginal Vault Prolapse repair and present our experience with a minimum of 1 year followup.Materials and Methods: The surgical technique involves 5 laparoscopic ports: 3 for the da Vinci® robot and 2 for the assistant. A polypropylene mesh is attached to the sacral promontory and Vaginal apex using polytetrafluoroethylene sutures. The mesh material is then covered by peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction and morbidity with a minimum of 12 months followup.Results: A total of 30 patients with post-hysterectomy Vaginal Vault Prolapse underwent robotic assisted laparoscopic sacrocolpopexy at our institution and 21 have a minimum of 12 months followup. Mean followup was 24 months (range 12 to 36) and me...
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gynecologic use of robotically assisted laparoscopy sacrocolpopexy for the treatment of high grade Vaginal Vault Prolapse
American Journal of Surgery, 2004Co-Authors: Daniel S Elliott, Igor Frank, David S Dimarco, George K ChowAbstract:Abstract Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade Vaginal Vault Prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with Vaginal repairs. In this article, we describe a novel minimally invasive technique of Vaginal Vault Prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the Vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic Vaginal Vault Prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1–12) months and mean age was 66 (range, 47–82) years. The mean total operative time was 3.2 (range, 2.25–4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for Vaginal Vault Prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.
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robotic assisted laparoscopic sacrocolpopexy for treatment of Vaginal Vault Prolapse
Urology, 2004Co-Authors: David S Di Marco, George K Chow, Matthew T Gettman, Daniel S ElliottAbstract:Abstract Introduction To describe and demonstrate the use and benefit of robotic-assisted laparoscopic sacrocolpopexy in the treatment of posthysterectomy Vaginal Vault Prolapse. Technical considerations The procedure combines the use of standard laparoscopy with the daVinci robotic system. The patient is placed in the dorsal lithotomy position. One camera port, two robotic ports, and two standard laparoscopic ports are placed transperitoneally. Standard laparoscopic dissection, in combination with an intraVaginal retractor, is used for initial anterior and posterior Vaginal mobilization and exposure of the sacral promontory. The daVinci robot is then docked and used to suture a silicone Y -shaped graft from the vagina to the sacral promontory. Culdoplasty, with plication of the uterosacral ligaments, is then performed, with the final step, retroperitonealization of the graft. Conclusions A total of 5 women have undergone this procedure, 3 with concomitant puboVaginal sling placement. All 5 women were discharged after 24 hours. No complications from the sacrocolpopexy were reported; however, 1 patient experienced transient Vaginal bleeding related to the puboVaginal portion of the case. No recurrent anterior, posterior, or apical Prolapse has occurred at mean of 4 months of follow-up. Using a robotic system for laparoscopic sacrocolpopexy facilitated precise intracorporeal suture placement so that the procedure could be done in a fashion similar to that of the open method. Robotic-assisted laparoscopic sacrocolpopexy may provide the same long-term durability of open sacrocolpopexy with the benefit of a minimally invasive approach.
Stefano Manodoro - One of the best experts on this subject based on the ideXlab platform.
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transVaginal levator myorrhaphy for posthysterectomy Vaginal Vault Prolapse repair
International Urogynecology Journal, 2018Co-Authors: Rodolfo Milani, Stefania Palmieri, Stefano Manodoro, Alice Cola, Matteo FrigerioAbstract:Posthysterectomy Vaginal Vault Prolapse repair represents a surgical challenge. Surgical management can be successfully achieved with native-tissue repair through levator myorrhaphy. Despite low morbidity, levator myorrhaphy is not a common procedure. The aim of the video is to provide anatomic views and surgical steps necessary to achieve a successful transVaginal levator myorrhaphy for Vaginal Vault Prolapse repair. A 72-year-old woman with symptomatic stage IV Vaginal Vault Prolapse was admitted for transVaginal levator myorrhaphy according to the described technique. Surgical repair was successfully achieved without complications. The final examination revealed good apical support and preservation of Vaginal length. This step-by-step video tutorial may represent an important tool to improve surgical know how. TransVaginal levator myorrhaphy provides an alternative technique for apical support without using prosthetic materials. This technique can be indicated when abdominal approach or synthetic device are not recommended or when peritoneum opening may be challenging. However, due to its possible constricting effect, it should be reserved to sexually inactive patients.
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transVaginal native tissue repair of Vaginal Vault Prolapse
Minerva ginecologica, 2018Co-Authors: Rodolfo Milani, Matteo Frigerio, Francesca Letizia Vellucci, Stefania Palmieri, Federico Spelzini, Stefano ManodoroAbstract:BACKGROUND Posthysterectomy Vaginal Vault Prolapse repair is a challenge for pelvic floor surgeons. Native-tissue repair procedures imply lower costs and reduced morbidity. Our study aims to evaluate operative data, complications, objective, subjective and functional outcomes of transVaginal native-tissue repair for posthysterectomy Vaginal Vault Prolapse. We also investigated differences among available techniques. METHODS Retrospective study including patients with symptomatic Vaginal Vault Prolapse (≥stage 2), previously treated with transVaginal Vault suspension through native-tissue repair. Objective recurrence was defined as the descent of at least one compartment ≥II stage according to Pelvic Organ Prolapse Quantification (POP-Q) system or need of reoperation. Subjective recurrence was defined as the presence of bulging symptoms. Patients satisfaction was evaluated with PGI-I Score. RESULTS The study included 111 patients. Apical suspension was achieved either by uterosacral ligament suspension (16), levator myorrhaphy (17), iliococcygeus fascia fixation (65) or sacrospinous ligament fixation (13). No intraoperative complications were observed. Perioperative/postoperative complications occurred in 8 patients (7.2%). Mean follow-up was 24.5±12.1 months. Objective recurrence was observed in 28 patients (25.2%). Reintervention was required by 3 patients (2.7%). Subjective recurrence was referred by 6 patients (5.4%). Mean satisfaction evaluated with PGI-I Score was 1.2±0.6. No differences in terms of operative data, overall complications, objective, subjective cure rate and perceived satisfaction were found among different techniques. CONCLUSIONS TransVaginal repair with native-tissue procedures is safe and effective in correcting posthysterectomy Vaginal Vault Prolapse and represents a valid alternative to prosthetic procedures for Vaginal Vault Prolapse treatment.
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transVaginal iliococcygeus fixation for posthysterectomy Vaginal Vault Prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Federico Spelzini, Stefano ManodoroAbstract:Posthysterectomy Vaginal Vault Prolapse repair is a surgical challenge. Successful surgical management using native tissue can be achieved via the Vaginal approach by iliococcygeus fascia fixation. However, although iliococcygeus fascia fixation is technically simple and has a low morbidity, it is not commonly performed. The aim of the video is to provide anatomic views and the surgical steps necessary to achieve successful transVaginal iliococcygeus fascia fixation for Vaginal Vault Prolapse repair. A 60-year-old woman with symptomatic stage III Vaginal Vault Prolapse was admitted for transVaginal iliococcygeus fascia fixation according to the described technique. Surgery was successful without complications. The final examination showed good apical support and preservation of Vaginal length. This step-by-step video tutorial may be an important tool to improve practical surgical knowledge. In particular, proper suture positioning requires adequate pararectal space preparation and levator ani exposure, as shown in the video. TransVaginal iliococcygeus fascia fixation is an alternative technique for apical support without the use of synthetic prosthetic materials. This technique may be indicated when an abdominal approach or a synthetic device is not recommended.
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transVaginal uterosacral ligament suspension for posthysterectomy Vaginal Vault Prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Federico Spelzini, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy Vaginal Vault Prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with native tissue using a Vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.
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transVaginal sacrospinous ligament fixation for posthysterectomy Vaginal Vault Prolapse repair
International Urogynecology Journal, 2017Co-Authors: Rodolfo Milani, Matteo Frigerio, Stefano ManodoroAbstract:Introduction and hypothesis Posthysterectomy Vaginal Vault Prolapse repair is a challenge for urogynecologists. Surgical management can be successful with native tissue by the Vaginal approach with sacrospinous ligament fixation. However, severe complications have been described, including nerve injury and life-threatening hemorrhage.
