The Learning Curve in Vaginal Pelvic Reconstruction Surgery for Severe Pelvic Organ Prolapse: Analysis of the Cumulative Summation Test (CUSUM)

Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeon A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32-54 vaginal pelvic reconstructive surgery procedures without mesh and 37-61 procedures in the same surgery with mesh. The surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. The learning phase of vaginal pelvic reconstructive surgery in advanced pelvic organ prolapse in this institutional cohort required 54 and 61 procedures, respectively. A higher number of procedures were required for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the boundary of proficiency, the surgical success rate and operation time were improved.

Single-Incision vs. Multiport Robotic Sacrocolpopexy: 126 Consecutive Cases at a Single Institution

Robot-assisted laparoscopic sacrocolpopexy (RSC) has gained popularity as a method for easier intracorporeal suturing than conventional laparoscopic sacrocolpopexy. However, few studies have compared multiport RSC (MP-RSC) and single-incision RSC (SI-RSC). We aimed to compare perioperative outcomes between these techniques for advanced pelvic organ prolapse (POP). We analyzed 126 patients who underwent RSC for POP quantification (all stage III to IV) between March 2019 and May 2021 at Seoul Asan Medical Center. We prospectively collected operation-related data, including total operation time (OT; from skin incision to closure) and perioperative outcomes. A total of 106 and 20 patients underwent MP-RSC and SI-RSC, respectively. The mean ages were 57.49 ± 10.89 and 56.20 ± 10.30 years in the MP-RSC and SI-RSC groups, respectively. The mean total OT was significantly shorter for MP-RSC than for SI-RSC (105.43 ± 24.03 vs. 121.10 ± 26.28 min). The OT difference was 15.67 min (95% confidence interval, 3.90–25.85, p = 0.009). No statistically significant differences were observed in terms of perioperative variables (estimated blood loss, hospital stay) and postoperative adverse events (POP recurrence, mesh erosion). SI-RSC had comparable intraoperative and postoperative outcomes to MP-RSC, with additional cosmetic benefits. MP-RSC had significantly shorter OT than SI-RSC.

The effect of reconstructive vaginal surgery on quality of life and sexual functions in postmenopausal women with advanced pelvic organ prolapse in intermediate-term follow-up

Objective To compare sexual function and quality of life in women who underwent McCall culdoplasty versus sacrospinous ligament fixation for pelvic organ prolapse. Materials and methods This study was conducted in our urogyanecology clinic between July 2015 and June 2019. We included sexually active postmenopausal women who had undergone either McCall culdoplasty ( n:80 patients) or sacrospinous ligament fixation ( n:38 patients) procedure for threatened POP. Patients in both groups were matched according to age and body mass index. Sexual function between both groups was evaluated with the pelvic organ prolapse/urinary incontinence sexual function 12 patient-reported outcome measures (PROMs) and quality of life with the prolapse quality of life (PQOL) PROMs. Results Emotional domain was low in the McCall culdoplasty group (21.4 ± 10.1 vs. 30.8 ± 15.2; p = 0.03). There were no significant differences in other P-QOL domains. Pain during intercourse was more in the sacrospinous ligament fixation group (2.9 ± 1.6 vs. 1.3 ± 1.1; p = 0.04). The mean operation time in the McCall culdoplasty group was shorter than the sacrospinous ligament fixation group ( p = 0.03). There was no difference between the two surgical procedures performed in terms of intraoperative blood loss and hospital stay. The prevalence of recurrence in the McCall culdoplasty group was 6.2%, and that of sacrospinous ligament fixation was 5% ( p = 0.75) in one year follow-up. Conclusion Our study demonstrated that McCall culdoplasty has a more positive effect on QOL and sexuality than sacrospinous ligament fixation in appropriately selected patients. McCall culdoplasty could be considered as a good option in the treatment of advanced pelvic organ prolapse in elderly patients.