Research Methods / Techniques
To elevate and suspend the apical end of the vagina, the uterosacral ligaments (USLs) were replaced by polyvinylidene fluoride (PVDF)-structures. These PVDF-structures were placed in the peritoneal folds of the USL at the pelvic wall to mimic the lateral and backward tension and to avoid rectal obstruction. A special tunneling device was used, which allowed the semi-circular placement of the structure without destroying the peritoneum.
The objective of this study was the implementation of a laparoscopic apical fixation in the treatment of pelvic organ prolapse and urinary incontinence.
In LACESA, subtotal hysterectomy was performed by dissecting the uterus above the origin of the USL at the cervix. The polyvinylidene-fluoride (PVDF) ligament-replacement structure was sutured to the cervix. The peritoneum over the first sacral vertebra (attachment of the USL) was blunt-opened and the USLs were “tunneld” towards cervix/vault on both sides and the PVDF-structure was placed into the peritoneal fold using a semi-circular tunneling device. The PVDF ligament-replacement structure was attached with three titanium helices to the prevertebral fascia of S1 on each side. The peritoneum above the cervix was closed.
Urinary incontinence symptoms were documented according to validated questionnaires, objective outcome according to POP-Q system.
50 patients underwent laCESA surgery. Median operating time was 94 minutes (74-194min). The tunneling device was pulled through the peritoneal folds of the USLs toward the cervix. The new USL-structures were brought to their physiological position. At 4 months, in 68% and 100% of patients urinary continence and apical prolapse were restored. The new technique did not lead to any complications and did not cause any side effects during 1-year follow-up.
Restoration of apical prolapse and urinary continence was achieved by bilateral USL replacement. This was technically achieved using a semi-circular tunneling device that was inserted through the lateral abdominal trocar incision.