Millions of women have pelvic organ prolapse (POP) worldwide, and it is a health problem associated with quality of life more than half of parous women aged over 50 years (1). POP is one of the most prevalent gynecological conditions requiring surgical treatment. Pectopexy using minimal invasive surgery was developed to reduce the short-term morbidity and recurrence associated with the open abdominal approach, providing the same results. We recently successfully performed prolapse surgery in POP patients, using a new laparoscopic and robotic pectopexy technique. The aim of this study is to evaluate the feasibility and safety of laparoscopic and robotic pectopexy in POP.

Data were retrospectively collected from database at Dong-san Medical Center, for POP patients who underwent laparoscopic or robotics pectopexy from January 2019 to September 2019. Laparoscopic pectopexy was performed through a standard multi-port (4 port) platform and robotic pectopexy was performed using the da Vinci Xi or X Surgical System (Intuitive Surgical, Sunnyvale, CA). The surgical procedure is retroperitoneum space from the isthmic portion of cervix to the iliopectineal ligament is exposed using unipolar. After completion of dissections, a polyvinylidene fluoride monofilament mesh was inserted into the abdominal cavity. The ends of the mesh were sutured to both iliopectineal ligaments via the intracorporeal suture technique, using nonabsorbable sutures. And mesh in the tension-free position was fixed to the cervicoisthmic portion of uterus with nonabsorbable sutures. Finally, the peritoneum dissected was sutured with an absorbable continuous suture.

Total 6 POP patients who underwent laparoscopic and robotic pectopexy were identified. We performed 3 of laparoscopic pectopexy and 3 of robotic pectopexy each. All procedures were successfully performed, without complication and conversion to laparotomy. The mean operation time was 100 minutes in laparoscopic surgery and 150 minutes in robotic surgery. After the operation, both patients were discharged after 2 days of admission. The patient returned to clinic at postoperative 10 days, and normal position of pelvic organ was confirmed by pelvic examination. The patient is currently follow-up state at postoperative 6 month without any recurrence or complication.

Overall, laparoscopic and robotic pectopexy were performed successfully without complication in terms of the surgical outcomes.

Laparoscopic and robotic pectopexy is feasible and safe in patients with apical POP. Operative times were reasonable and surgical procedure was well tolerated by patients. Further evaluation should be performed in large-scale comparative studies with vaginal or abdominal approach to confirm the safety and benefits of laparoscopic and robotic pectopexy in apical POP.

Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98:646-51.