Positive symptom improvement with laparoscopic uterosacral ligament repair for uterine or vaginal vault prolapse: interim results from an active multicenter trial.
OBJECTIVE
To evaluate the use of laparoscopic uterosacral ligament repair for long-term patient symptom improvement in patients with uterine prolapse or posthysterectomy vaginal vault prolapse and to evaluate how laparoscopic instrumentation kits facilitate procedure performance for the surgeon.


METHODS
Nonrandomized, prospective, multicenter case series (Canadian Task Force classification II-2).


METHODS
Five clinical sites consisting of 4 community hospitals and 1 university medical center.


METHODS
Seventy-two patients with stage II or worse uterine prolapse (58%, n = 42) or posthysterectomy vaginal vault prolapse (42%, n = 30). One patient with stage I vaginal vault prolapse was included in the group due to her significant symptoms.


METHODS
Laparoscopic uterosacral ligament repair was performed on all patients; round ligament truncation was also performed selectively on patients with uterine prolapse. Fifty-seven percent (41 patients) had concomitant pelvic procedures.


RESULTS
At 12-month follow-up, Pelvic Organ Prolapse Quantification (POP-Q) scores and patient self-reported symptom scores were significantly improved over baseline after laparoscopic repair of pelvic organ prolapse. Positive mean change in POP-Q score was 14.4 (p = .0003) for uterine prolapse repair and 9.28 (p = .017) for vaginal vault prolapse repair. Positive mean change in total symptom score was 20.36 (p <.0001) for uterine prolapse repair and 11.43 (p = .005) for vaginal vault prolapse repair. Surgeons reported a mean procedure time of 31.6 minutes for uterine prolapse repair and 21.7 minutes for vaginal vault prolapse repair. A mean rating of 7.5 was documented for ease of use for the uterine prolapse kit and 4.1 for the vaginal vault prolapse kit on a scale of 1 to 10.


CONCLUSIONS
Laparoscopic uterosacral ligament repair improves symptoms and POP-Q scores over the long term in patients with uterine or vaginal vault prolapse. Laparoscopic instrumentation kits facilitate procedure performance for the surgeon with expedited surgery times.
Schwartz
Marlan
M
Lifeline Medical Associates, Piscataway, New Jersey 08854, USA. tricountyobg@aol.com
Abbott
Karen Rae
KR
Glazerman
Larry
L
Sobolewski
Craig
C
Jarnagin
Barry
B
Ailawadi
Radhika
R
Lucente
Vincent
V
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012404:Round Ligament of Uterus / Q000601:surgery; D012720:Severity of Illness Index; D013536:Suture Techniques / Q000295:instrumentation*; D014596:Uterine Prolapse / Q000601:surgery*