Comparing minimally invasive sacrocolpopexy to vaginal uterosacral ligament suspension: A multicenter retrospective cohort study through the Fellows’ Pelvic Research Network

• Type of Material: Article
• Authors: Nabila Noor, Harvard University; Dina Bastawros, Atrium Health; Marian E Florian-Rodriguez, University of Texas, Dallas, Texas; Deslyn Hobson, University of Louisville; Chidimma Eto, Emory University; Svjetlana Lozo, NorthShore University; Erin Lavelle, University of Pittsburgh; Danielle Antosh, Houston Methodist Hospital; Michele R Hacker, Harvard University; Eman Elkadry, Harvard University; Emily Von Bargen, Harvard University
• Language: English
• Date: 2022-07-09
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Urogynecologic Society. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097%2FSPV.0000000000001226
• Title of Journal or Parent Work: Urogynecology
• Volume: 28
• Issue: 10
• Start Page: 687
• End Page: 694
• Grant/Funding Information: The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers.; This works was conducted with support from Harvard Catalyst
• Keywords: apical support; surgical outcomes; uterosacral ligament suspension; complications; pelvic organ prolapse; laparoscopic and robotic sacrocolpopexy
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

IMPORTANCE: Surgical outcomes OBJECTIVES: To compare anatomic outcomes after minimally invasive sacrocolpopexy (MISC) and vaginal uterosacral ligament suspension (vUSLS). STUDY DESIGN: This was a multi-center, retrospective cohort study through FPRN. Patients with ≥ stage II pelvic organ prolapse (POP) who underwent MISC or vUSLS from January 2013 to January 2016, identified through the CPT codes, with ≥ one year of postoperative data were included. Patients with prior POP surgery or history of connective tissue disorders were excluded. Anatomic success was defined as POP-Q measurements: Ba/Bp ≤ 0 or C ≤ −TVL/2. Data were compared using chi-square or Fisher’s exact tests. Continuous data were compared using Wilcoxon rank sum test. RESULTS: Three hundred and thirty-seven patients underwent MISC (171 laparoscopic, 166 robotic) and 165 underwent vUSLS. The MISC group had longer operative time (205.9 mins vs 187.5 mins, p =0.006) and lower blood loss (77.8 ml vs 187.4 ml; p< 0.001). Two patients (0.6%) in the MISC group had mesh exposure requiring surgical excision. Permanent suture exposure was higher after vUSLS (6.1%). At one-year, anatomic success was comparable in the apical (322 [97%] MISC vs 160 [97%] vUSLS, p=0.99) and posterior compartments (326 [97.6%] MISC vs 164 [99.4%] vUSLS; p=0.28). Anterior compartment success was higher in the MISC group (328 [97.9%] vs 156 [94.9%], p=0.04) along with longer TVL (9.2 ±1.8 vs 8.4 ±1.5, p<0.001). CONCLUSION: At one-year, patients who underwent MISC or vUSLS had similar apical support. Low rates of mesh and suture exposures, less anterior recurrence and longer TVL were noted after MISC.