Sacrocolpopexy: anatomical landmarks, clinical appliance and 3-year outcomes

Abstract

Background: Sacrocolpopexy (SCP) is one of the most popular and approved surgical methods of correction of the apical pelvic organ prolapse (POP). This intervention has been adjusted to a laparoscopic approach for more than 20 years. Mini-invasive surgery’s advantages combined with dependable results of augmentation allowed to adopt it worldwide in most urogynecological wards. Nevertheless, SCP is not so basic in performance, so it can cause many difficulties during surgery, especially at first. This article describes step-by-step instruction of promontofixation performed either laparoscopically or robotically with the classic two-strap technique, focusing on anatomical landmarks and present our anatomical, and functional long-term outcomes covering up to 7 years of observation. Methods: Intervention could be divided into two big steps: (I) wide dissection and retroperitoneal tissue preparation combined with subtotal hysterectomy; (II) fixation of the mesh with non-absorbable sutures and peritoneal closure. During 2013–2020 years in Moscow Regional Scientific Research Institute of Obstetrics and Gynecology SCP was performed in 387 patients, 193 using laparoscopic approach and 194 robotic-assisted. For recurrence cases of POP, we took the criteria by International UroGynecological Association: direct or indirect genital prolapse reaching or going below the level of the hymen (POP-Q ≥ stage 2b) for objective recurrence. Functional outcomes were evaluated by international validated questionnaires by achieving the minimal clinical important difference (MCID) in points, previously approved by studies. Results: Our 3-year long-term outcomes resulted in 29 cases of POP recurrence (8.1%). Twenty-six of them were resulted in cystocele (7.3%), 4 (1.1%) in rectocele and 2 (0.6%) in apical prolapse. Clinical improvement based on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) score was met in 132 (66.3%) patients, 250 (70.0%) of women improved pelvic floor dysfunction Pelvic Floor Distress Inventory-20 (PFDI-20) and 205 (57.4%) of patients improved their social life according to Pelvic Floor Inventory Questionnaire-7 (PFIQ-7) score. Conclusions: Our long-term results reflect, that this method may not be advised in cases with anterior-apical prolapse, because of the high risk for prolapse recurrence (7.3%) and surgical imperfection of safe and avascular dissection of the anterior vaginal wall. However, in patients with complex and posterior-apical prolapse, such intervention still should be considered as a “gold standard”. 8