Laparoscopic approach in the pelvic floor surgery

Authors: S. Manodoro 1,2;  E. Werbrouck 1;  J. Veldman 1;  K. Haest 1,3;  R. Corona 1;  F. Claerhout 1,4;  G. Coremans 1;  D. De Ridder 1;  F. Spelzini 2;  J. Deprest 1
Authors‘ workplace: Pelvic Floor Unit, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium 1;  Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, University of Milan-Bicocca, Milan, Italy 2;  Vie Curie, Venlo, Netherlands 3;  Bekkenbodemkliniek, AZ Sint Lucas, Brugge, Belgium 4
Published in: Ceska Gynekol 2011; 76(6): 418-424
Category: Original Article


Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.

Key words:
laparoscopy, pelvic floor surgery, morbidity.


1. Garry, R., Fountain, J., Mason, S., et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ, 2004, 328, p. 129-136.

2. Tan, E., Tekkis, PP., Cornish, J., et al. Laparoscopic versus open colposuspension for urodynamic stress incontinence. Neurourol Urodyn, 2007, 26, p. 158-169.

3. Maher, C., Qatawneh, A., Baessler, K., et al. Laparoscopic colposuspension or tension-free vaginal tape for recurrent stress urinary incontinence and/or intrinsic sphincter deficiency - a randomized controlled trial. Neurourol Urodyn, 2004, 23(5/6), p. 433-434.

4. Paraiso, MF., Walters, M., Karram, M., et al. Laparoscopic Burch colposuspension versus the tension-free vaginal tape procedure: a randomised controlled trial. Neurourol Urodyn, 2004, 22(5), p. 487-488.

5. Jelovsek, JE., Barber, MD., Karram, MM., et al. Randomized trial of laparoscopic Burch colposuspension versus ternsion-free vaginal tape: long term follow up. BJOG, 2008, 115, p. 219-225.

6. Dean, N., Herbison, P., Ellis, G., et al. Laparoscopic colposuspension and tension-free vaginal tape: a systematic review. BJOG, 2006, 113(12), p. 1345-1353.

7. DeLancey, JOL. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol, 1992, 166, p. 1717-1728.

8. Maher, C., Baessler, K., Glazener, CMA., et al. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004014. DOI: 10.1002/14651858.CD004014.pub3.

9. Nezhat, CH., Nezhat, F., Nezhat, C. Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gynecol, 1994, 84, p. 885-888.

10. Shull, BL. Pelvic organ prolapse: Anterior, superior and posterior vaginal segment defects. Am J Obstet Gynecol, 1999, 181, p. 6-11.

11. Marchionni, M., Bracco, GL., Checcucci, V., et al. True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med, 1999, 44(8), p. 679-684.

12. Dällenbach, P., Kaelin-Gambirasio, I., Jacob, S., et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19(12), p. 1623-1629.

13. Blandon, RE., Bharucha, AE., Melton, LJ. 3rd, et al. Risk factors for pelvic floor repair after hysterectomy. Obstet Gynecol, 2009, 113(3), p. 601-608.

14. Cruikshank, SH. Preventing posthysterectomy vaginal vault prolapse and enterocele during vaginal hysterectomy. Am J Obstet Gynecol, 1987, 156(6), p. 1433-1440.

15. Maher, CF., Qatawneh, AM., Dwyer, PL., et al. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol, 2004, 190(1), p. 20-26.

16. Shull, BL., Bachofen, C., Coates, KW., Kuehl, TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol, 2000, 183(6), p. 1365-1373; discussion p. 1373-1374.

17. Karram, MM., Sze, EH., Walters, MD. Surgical treatment of vaginal vault prolapse. In: Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery; 2nd ed. St. Louis: Mosby; 1999, p. 235-256.

18. Hale, DS., Rogers, RM. Jr. Abdominal sacrospinous ligament colposuspension. Obstet Gynecol, 1999, 94(6), p. 1039-1041.

19. Addison, WA., Livengood, CH. 3rd, Sutton, GP., Parker, RT. Abdominal sacral colpopexy with Mersilene mesh in the retroperitoneal position in the management of posthysterectomy vaginal vault prolapse and enterocele. Am J Obstet Gynecol, 1985, 153(2), p. 140-146.

20. Bump, R., Mattiasson, A., BĮ, K., et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol, 1996, 175, p. 10-17.

21. Visco, AJ., Weidner, AC., Barber, MD., et al. Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol, 2001, 184, p. 297-302.

22. Krause, HG., Goh, JT., Sloane, K., et al. Laparoscopic sacral suture hysteropexy for uterine prolapse. Int Urogynecol J Pelvic Floor Dysfunct, 2006, 17(4), p. 378-381.

23. Claerhout, F., De Ridder, D., Roovers, JP., et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol, 2008, Dec 17.

24. Ramsay, CR., Wallace, SA., Garthwaite, PH., et al. Assessing the learning curve effect in health technologies. Lessons from the nonclinical literature. Int J Technol Assess Health Care, 2002, 18(1), p. 1-10.

25. Digesu, GA., Khullar, V., Cardozo, L., et al. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J, 2005, 6, p. 176-181.

26. Claerhout, F., Moons, P., Ghesquiere, S., et al. Validity, reliability and responsiveness of a Dutch version of the prolapse quality-of-life questionnaire. Int Urogynaecol J (in press).

27. Cosson, M., Rajabally, R., Bogaert, E., et al. Laparoscopic sacrocolpopexy, hysterectomy and Burch colposuspension: feasibility and short-term complications of 77 procedures. J Soc Lap Surg, 2002, 6, p. 115-119.

28. Elliott, DS., Frank, I., DiMarco, DS., Chow, GK. Gynecologic use of robotically assisted laparoscopy: sacrocolpopexy for the treatment of high-grade vaginal vault prolapse. Am J Surg, 2004, 188, p. 52S-56S.

29. Antiphon, P., Elard, S., Benyoussef, A., et al. Laparoscopic promontory sacral colpopexy: Is the posterior recto-vaginal mesh mandatory. Eur Urol, 2004, 45, p. 655-661.

30. Gadonneix, P., Ercoli, A., Salet-Lizée, D., et al. Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse. J Am Assoc Gynecol Laparosc, 2004, 11, p. 29-35.

31. Rozet, F., Mandron, E., Arroyo, C., et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urology, 2005, 47, p. 230-236.

32. Higgs, PJ., Chua, HL., Smith, ARB. Long term review of laparoscopic sacrocolpopexy. BJOG, 2005, 112, p. 1134-1138.

33. Paraiso, MF., Walters, MD., Rackley, RR., et al. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol, 2005, 192, p. 1752-1758.

34. Rivoire, C., Botchorishvili, Canis, M., et al. Complete laparoscopic treatment of genital prolapse with meshes including vaginal promontofixation and anterior repair: a series of 138 patients. J Minim Invasive Gynecol, 2007, 14, p. 712-718.

35. Agarwala, N., Hasiak, N., Shade, M. Laparoscopic sacral colpopexy with Gynemesh as graft material - experience and results. J Minim Invasive Gynecol, 2007, 14, p. 577-583.

36. North, CE., Ali-Ross, NS., Smith, ARB., et al. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG, 2009, 116, p. 1251-1257.

37. Price, N., Slack, A., Jackson, SR. Laparoscopic sacrocolpopexy: an observational study of functional and anatomical outcomes. Int Urogynecol J, 2010.

38. Granese, R., Candiani, M., Perino, A., et al. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obs Gyn and Reprod Biol, 2009, 146, p. 227-231.

39. Sabbagh, R., Mandron, E., Piussan, J., et al. Long-term anatomical and functional results of laparoscopic promotofixation for pelvic organ prolapse. BJUI, 2010, 106, p. 861-866.

40. Ganatra, AM., Rozet, F., Sanchez-Salas, R., et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol, 2009, 55, p. 1089-1095.

41. Nygaard, IE., McCreery, R., Brubaker, L., et al. for the Pelvic Floor Disorders Network. Abdominal sacrocolpopexy : a comprehensive review. Obstet Gynecol, 2004, 104, p. 805-823.

42. Deprest, J., De Ridder, D., Roovers, JP., et al. Medium term outcome of laparoscopic sacrocolpopexy with xenografts compared to synthetic grafts. J Urol, 2009, 182(5), p. 2362-2368. Epub 2009 Sep 16.

43. Claerhout, F., Lewi, P., Verguts, J., et al. Analysis of the learning curve for laparoscopic sacrocolpopexy: identification of challenging steps. Int Urogynecol J, 2009, 20, (suppl 2), p. S202-S203 (153).

44. Akladios, CY., Dautun, D., Saussine, A., et al. Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obst Gyn and Reprod Biol, 2010,149, p. 218-221.

45. Mottrie, A., Martens, P., Bollens, R., et al. Laparoscopic colpopromontofixation. Aktuelle Urol, 2005, 36(2), p. 157-165.

46. Elliott, DS., Krambeck, AE., Chow, GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol, 2006, 176(2), p. 655-659.

47. Di Marco, DS., Chow, GK., Gettman, MT., Elliott, DS. Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology, 2004, 63(2), p. 373-376.

48. Kramer, BA., Whelan, CM., Powell, TM., Schwartz, BF. Robot-assisted laparoscopic sacrocolpopexy as management for pelvic organ prolapse. J Endourol, 2009, 23(4), p. 655-658.

49. Akl, MN., Long, JB., Giles, AL., et al. Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc, 2009, 23, p. 2390-2394.

50. Judd, PJ., Siddiqui, NY., et al. Cost-minimization analysis of robotic-assisted, laparoscopic and abdominal sacrocolpopexy. Min Inv Gynecol, 2010, 17(4), p. 493-499.

51. Claerhout, F.. The introduction of laparoscopy and novel biomatrices for surgical repair of vaginal vault prolapse by sacral colpopexy. Thesis Manuscript. Leuven: Leuven Academic Press, 2010, 185 p.

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