Laparoscopic correction of combined forms of genital prolapse

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BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.

AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.

MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades II–IV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients’ medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.

RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patient’s satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.

CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patient’s quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

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About the authors

Dmitrii V. Bryunin

I.M. Sechenov First Moscow State Medical University

ORCID iD: 0000-0002-5969-4217

MD, Dr. Sci. (Med.), Professor

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991

Yurii V. Chushkov

I.M. Sechenov First Moscow State Medical University

ORCID iD: 0000-0001-8125-1829

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991

Alina N. Pyatkina

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
ORCID iD: 0000-0002-4260-9661

post-graduate student

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991


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Supplementary files

Supplementary Files
1. Fig. 1. The first longitudinal-shaped implant with protrusions is placed longitudinally with a wide base into the rectovaginal space.

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2. Fig. 2. The first implant is fixed with separate sutures with a non-absorbable thread to the bundles of muscles that raise the anus on both sides.

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3. Fig. 3. The second transverse implant is fixed with the ends to the comb ligaments by separate sutures with a non-absorbable thread.

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4. Fig. 4. The transverse implant is fixed with the central part also to the stump of the vagina or cervix, and the ends to the comb ligaments with separate sutures with a non-absorbable thread.

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5. Fig. 5. The design of connected implants, with fixation in the central area, forms a reliable structure, and each of them performs its function of supporting the pelvic organs, both along (1st implant), in the area of the longitudinal axis of the sagittal plane, and across (2nd implant), in the area of the transverse axis.

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