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Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse

BACKGROUND AND OBJECTIVES: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterec...

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Autores principales: Bolovis, D.I., Brucker, C.V.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Universa Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10191708/
https://www.ncbi.nlm.nih.gov/pubmed/35781115
http://dx.doi.org/10.52054/FVVO.14.2.015
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author Bolovis, D.I.
Brucker, C.V.M.
author_facet Bolovis, D.I.
Brucker, C.V.M.
author_sort Bolovis, D.I.
collection PubMed
description BACKGROUND AND OBJECTIVES: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation. MATERIALS AND METHODS: Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position. MAIN OUTCOME MEASURES: For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system. RESULTS: Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored. CONCLUSIONS: Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair.
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spelling pubmed-101917082023-05-18 Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse Bolovis, D.I. Brucker, C.V.M. Facts Views Vis Obgyn Video Article BACKGROUND AND OBJECTIVES: There are numerous vaginal and abdominal surgical approaches for the treatment of pelvic organ prolapse (POP). Even the standard techniques show great variability due to modifications depending on anatomy, available instruments and materials. Recently, the role of hysterectomy in prolapse surgery as well as the use of synthetic meshes have been questioned. Here, we present a standardised mesh-free minimally invasive pelvic floor reconstruction technique with uterus preservation. MATERIALS AND METHODS: Unilateral pectineal suspension (UPS) is carried out in five defined steps with the use of the da Vinci Xi® surgical system. The desired anatomical result is simulated by intraoperative uterus manipulation. The cranial part of the pectineal ligament is used for lateral fixation. A non-absorbable suture is placed between the pectineal ligament and the anterior cervix to suspend the uterus in its natural anatomical position. MAIN OUTCOME MEASURES: For outcome measurement, degree of prolapse was assessed pre- and postoperatively according to the POP-Q system. RESULTS: Unilateral pectineal suspension offers several advantages. Medial tension-free positioning of the uterus is achieved. The use of the cervix as fixation structure allows for excellent pelvic floor support and stable results. Normal pelvic floor mobility and natural axis of the vagina are restored. CONCLUSIONS: Unilateral pectineal suspension is an efficient minimal-invasive mesh-free procedure which allows uterus preservation and offers reliable level I support respecting the physiological pelvic anatomy. In addition, there is no need for ureteral dissection or bowel manipulation. The technique offers clinical standardization and can easily be integrated into the spectrum of modern surgical POP repair. Universa Press 2022-07-01 /pmc/articles/PMC10191708/ /pubmed/35781115 http://dx.doi.org/10.52054/FVVO.14.2.015 Text en Copyright © 2022 Facts, Views & Vision https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Video Article
Bolovis, D.I.
Brucker, C.V.M.
Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title_full Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title_fullStr Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title_full_unstemmed Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title_short Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse
title_sort unilateral pectineal suspension – a new surgical approach for apical correction of pelvic organ prolapse
topic Video Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10191708/
https://www.ncbi.nlm.nih.gov/pubmed/35781115
http://dx.doi.org/10.52054/FVVO.14.2.015
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