Device Selection Contributes to Operative Time Reduction in Laparoscopic Sacrocolpopexy

Abstract

Objectives: The standard laparoscopic sacrocolpopexy (LSC) technique involves several suture fixation sites, which can prolong the operative time. This study aimed to investigate the extent to which the operative time could be shortened using devices such as tackers in sites where suture manipulation could be omitted.

Materials and methods: The study enrolled 82 patients who underwent LSC at our hospital between May 2016 and May 2022. The median operative time was 3.2 h (1.78-6.5 h). Changes in symptoms before and after surgery were measured using several questionnaires and 60-min pad weight testing among patient groups based on the device used.

Results: Among the preoperative factors, no factors were found to be significantly correlated with the operative time (≥3.2 h or <3.2 h). As intraoperative factors, significant associations were found between the number of tackers used on the posterior vaginal wall, anterior vaginal wall, and cervix (0-3 locations), whether a device was used in mesh retroperitonealization, whether the first needle used to fix the anterior longitudinal ligament was successful, whether adhesion dissection was performed, and the type of sealing device. Among these factors, the use of tackers on the posterior wall, anterior wall, and cervix and the use of a device in mesh retroperitonealization were significantly associated with the operative time.

Conclusion: The use of easy-to-operate devices appeared to contribute to a shorter operative time in LSC.

Keywords: Fixation device; laparoscopic sacrocolpopexy; mesh retroperitonealization.

Figure 1

(a) The anterior and posterior wall meshes were suture fixed at all points. (b) The mesh was fixed using tackers at the anterior wall, posterior wall, and uterine cervix. (c) All incised peritoneum was closed with sutures. (d and e) After the formation of the retroperitoneal tunnel, the peritoneal incision over the promontory was closed with sutures (d) or clips (e)

Figure 2

Box plots reveal a significant decrease in the operative time among the three groups. (a) The operative time significantly reduced in the group using tackers at all three sites compared with the group using suture fixation at all three sites (P < 0.0001). (b) The group using retroperitoneal tunneling and clip closure showed a significantly shorter operative time than the group using peritoneal incision and suture closure (P < 0.0001). (c) Scatter plot and approximate curve show that surgical time was reduced along with the use of multiple devices