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. 2022 Jul;33(7):1949-1956.
doi: 10.1007/s00192-021-04934-4. Epub 2021 Aug 18.

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

Fei Chi Chuang #  1 , Yu Min Chou #  1 , Ling Ying Wu  1 , Tsai Hwa Yang  1 , Wen Hsin Chen  1 , Kuan Hui Huang  2
Affiliations

Laparoscopic pectopexy: the learning curve and comparison with laparoscopic sacrocolpopexy

Fei Chi Chuang et al. Int Urogynecol J. 2022 Jul.

Abstract

Introduction and hypothesis: In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS.

Methods: We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed.

Results: The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse.

Conclusions: Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.

Keywords: Laparoscopy; Learning curve; Pectopexy; Pelvic organ prolapse; Sacrocolpopexy.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
The design of the trocar sites. a In laparoscopy, the surgeon used trocars 2 and 3 and the assistant used trocar 1. C camera trocar over the umbilicus. b In robotic surgery (Da Vinci Si system), no assistant port was needed. The numbers 1 and 2 represent arms 1 and 3 respectively. C camera trocar
Fig. 2
Fig. 2
Steps of pectopexy. a The peritoneum was opened to dissect the bladder and expose the cervix (star). b The peritoneum was opened along the pubic bone (dotted line) between the right round ligament (black star) and the right medial umbilical ligament (white star) to expose the pectineal ligament (arrow). The external iliac vessels lie on the superolateral part of the pectineal ligament (arrowhead). c The middle part of the mesh is fixed on the exposed uterine cervix (star). d The mesh end is anchored to the left pectineal ligament by AbsorbaTack™. The retroperitoneal tunnel from the cervix to the left pectineal ligament (arrow). e Reperitonization after mesh fixation. f Intraoperative cystoscopy. The surface indentation of the pectopexy mesh over the bladder dome (arrow). g The obturator neurovascular bundle (white arrow) is at the inferolateral part of the left pectineal ligament. Arrowhead: left medial umbilical ligament. h The pubic vein lies on the left pectineal ligament (arrow)
Fig. 3
Fig. 3
Distribution of the operation time. a Operation time of laparoscopic pectopexy and laparoscopic sacrocolpopexy. b Learning curve of laparoscopic pectopexy. The turning point of the learning curve was the 12th case
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Comment in

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