Virginia Mason Medical Center, Seattle, WA

Introduction and Objectives: Laparoscopic sacrocolpopexy is becoming increasingly utilized for the management of vaginal vault prolapse. The purpose of this study was to determine surgical complications associated with a minimally invasive approach.

Methods: The IRB approved database at Virginia Mason Medical Center was reviewed for laparoscopic sacrocolpopexies performed from 2002-2006. Cases that were converted to an open or transvaginal approach were excluded from further analysis. Information on patient and surgical characteristics was then abstracted from the computerized medical record. All procedures were performed by a single laparoscopic surgeon in combination with one of two female urologists. In all cases, a Y-configured mesh was sutured to the anterior and posterior vaginal walls and then anchored to the sacral promontory using the Straight-In Drill (AMS).

Results: Forty-five women were identified who had a successful laparoscopic sacrocolpopexy. There were an additional three cases converted to an open approach, and one that was converted to transvaginal approach secondary to extensive adhesions. Those who had a completed laparoscopic sacrocolpopexy had a mean follow-up of 6.1 months (range 2 weeks-27 months). The presenting chief complaint was vaginal bulging in all patients. The mean age was 66.7 years (SD 8.9 years) and all were postmenopausal. Most (51.1%) of the women were sexually active. Preoperative Baden-Walker grading was 2 (33.3%), 3 (46.7%) and 4 (17.8%). Seventeen (37.8%) of the patients had undergone previous abdominal surgery and 31 (68.9%) and 24 (53.3%) had a history of prolapse repair and surgery for incontinence, respectively. Nearly half (46.7%) underwent simultaneous procedures that included a sling, anterior or posterior colporrhaphy. Most of the women (96%) were discharged within 48 hours. The overall surgical complications included 4 (8.9%) mesh or suture erosions, 5 (11.1%) with new or persistent stress incontinence requiring a subsequent procedure, 3 (6.7%) nonspecific bowel symptoms, one vaginal injury repaired intraoperatively (2.2%) and one bladder injury managed with foley decompression (2.2%) and one recurrence (2.2%) at 20 months follow-up. Of those known to be sexually active, 5 (23.8%) had new onset dyspareunia postoperatively, and of these women, 3 (50%) did not have a concomitant procedure performed. No woman with dyspareunia had a simultaneous rectocele repair. The sole medical complication was a postoperative myocardial infarction with pneumonia.

Conclusions: We have had excellent short-term success with laparoscopic sacrocolpopexy, and this includes women who have had previous abdominal surgery. Although the mesh erosion rate using silicone was high, we have not had any cases of erosion since transitioning to polypropylene mesh. The observation of dyspareunia and bowel complaints postoperatively warrants further investigation. Laparoscopic sacrocolpopexy is a minimally invasive procedure with a unique set of complications for which the patient should be appropriately counseled.

UroToday.com Coverage of SUFU 2007

UroToday.com Laproscopic and Robotic Section

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