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      Laparoendoscopic single-site (LESS) sacrocolpopexy: feasibility and efficacy of knotless procedure performed with conventional instruments

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          Abstract

          The aim of this paper was to report a case of a patient with stage IV vaginal vault prolapse treated by laparoendoscopic single-site (LESS) sacrocolpopexy using an Alexis retractor and a surgical glove attached to three trocars through a 3.5-cm umbilical incision. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix and to the sacral periosteum from the promontory using running sutures hold in the extremities by polymer clips. The posterior peritoneum was closed over the mesh. LESS sacrocolpopexy performed with conventional instruments is a difficult but feasible and efficient technique to treat vaginal vault prolapse that respects the principles of conventional laparoscopic or open repairs. Alexis retractor associated with knotless sutures are technical options that simplify LESS reconstructive surgical maneuvers.

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          Retroperitoneal laparoendoscopic single-site surgery in urology: initial experience.

          Hee Oh, Soo Ryu, Neung-Hwa Park (2009)
          To present our initial experience with single-port laparoscopic urologic surgery via the retroperitoneal approach using the Alexis wound retractor with flexible laparoscopic instrumentation. Since December 2008, 14 patients have undergone single-port laparoscopic surgery for various urological diseases, including renal cyst decortication in 5 patients, adrenalectomy in 2 patients, nephroureterectomy in 2 patients, nephrectomy in 3 patients, and ureterolithotomy in 2 patients. For the retroperitoneal approach, the Alexis wound retractor with a single port was used. All cases were completed without conversion to standard laparoscopic or open surgery. The mean operative time and mean estimated blood loss for decortication of the renal cysts were 56 minutes (range 45-70 minutes) and 179 mL (range 22-398 mL), respectively; the mean operative time and mean estimated blood loss for extirpative or reconstructive surgery were 156 minutes (range 115-21 minutes) and 403 mL (range 35-1324 mL), respectively. The mean hospital stay was 6.5 days (range 4-14 days). There were no major intraoperative complications, but wound dehiscence and bleeding were noted in two patients. Retroperitoneal single-port laparoscopic urologic surgery, particularly in patients requiring free-hand suturing, is technically feasible. The initial clinical experience of organ-ablative, extirpative, and reconstructive surgery with this approach is reported.
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            Vaginal Vault Prolapse

            Azubuike Uzoma, K. Farag (2009)
            Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.
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              Single-port laparoscopic abdominal sacral colpopexy: initial experience and comparative outcomes.

              Wesley White, Raj Goel, Mia Swartz … (2009)
              To determine the efficacy and safety of single-port laparoscopic abdominal sacral colpopexy (ASC) for the treatment of female pelvic organ prolapse (POP). A retrospective cohort study was performed to assess perioperative outcomes among women who were treated for symptomatic POP with laparoscopic, robotic, or single-port laparoscopic ASC. All patients underwent preoperative history and physical examination including POP quantification (POP-Q) staging and urodynamics. ASC with or without anti-incontinence surgery was performed via the aforementioned approaches. Demographic and perioperative data were obtained. Patients were followed up postoperatively at 3 and 6 months with POP-Q evaluation. Statistical analysis was performed. From October 2005 to July 2008, 30 female patients with symptomatic Stage II (6 patients), Stage III (23 patients), or Stage IV (1 patient) POP were treated with laparoscopic (10), robotic (10), or single-port laparoscopic (10) ASC. Mean age of the entire cohort was 61.1 years. Mean body mass index was 26.7 kg/m(2). Seventeen patients demonstrated stress urinary incontinence and underwent concomitant sling placement. No intraoperative complications were encountered. No significant difference was noted in the 3 cohorts with respect to operative time, blood loss, mean visual analog pain score at discharge, or duration of hospitalization. At 6 months following surgery, 27 patients underwent follow-up POP-Q, with all patients demonstrating excellent apical support and prolapse reduction. Single-port laparoscopic ASC offers comparable efficacy and superior cosmesis compared to alternative approaches. Long-term follow-up is needed to confirm durability of repair.
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                Author and article information

                Contributors
                : +55-11-49935462 , +55-11-44360003 , andre.tome@sbu.org.br
                Journal
                Journal ID (nlm-ta): Int Urogynecol J
                Title: International Urogynecology Journal
                Publisher: Springer-Verlag (London )
                ISSN (Print): 0937-3462
                ISSN (Electronic): 1433-3023
                Publication date (Electronic): 6 April 2011
                Publication date PMC-release: 6 April 2011
                Publication date (Print): July 2011
                Volume: 22
                Issue: 7
                Pages: 885-887
                Affiliations
                [1 ]Department of Urology, ABC Medical School, Santo Andre, Brazil
                [2 ]Disciplina de Urologia–Faculdade de Medicina do ABC–Fundacao ABC, Av. Principe de Gales, 821–Anexo II, CEP 09060-650 Santo Andre, SP Brazil
                Article
                Publisher ID: 1363
                DOI: 10.1007/s00192-011-1363-x
                PMC ID: 3112326
                PubMed ID: 21468741
                SO-VID: 4d1221e9-2711-4f11-a10a-2fd5fa30eb0c
                Copyright © © The Author(s) 2011
                History
                Date received : 15 September 2010
                Date accepted : 14 January 2011
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The International Urogynecological Association 2011

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: vaginal vault prolapse,sacrocolpopexy,laparoendocopic single-site surgery
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: vaginal vault prolapse, sacrocolpopexy, laparoendocopic single-site surgery

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