The challenge of implementing laparoscopic sacrocolpopexy.
Vaginal-vault prolapse is effectively treated using sacrocolpopexy (SCP). A randomized trial demonstrated that it can be performed as effectively via laparoscopy (LSCP) as via laparotomy and with less morbidity. This evidence begs the question of how units offering abdominal sacrocolpopexy will implement LSCP. Several limitations need to be overcome. LSCP initially requires longer operating time; however, that decreases with surgeon experience. To decrease operation time, suture training can be implemented ahead. Following a 15-h suturing lab, trainees achieved comparable operation times after 30 cases. Dissection is another critical time-consuming step and is difficult to model. Proficiency is more dependent on patient characteristics, though this component is poorly studied. One experience showed it takes 60 procedures to effectively limit complications. The large number of patients required for surgeon training for this relative infrequent operation creates a problem, thus limiting the number of centers available for training surgeons within a reasonable period.
Department Development and Regeneration, Faculty of Medicine & Pelvic Floor Unit, University Hospitals, KU Leuven, 3000, Leuven, Belgium, Jan.Deprest@uzleuven.be.
Jan
J
Deprest
Ladislav
L
Krofta
Frank
F
Van der Aa
Alfredo L
AL
Milani
Jan
J
Den Boon
Filip
F
Claerhout
Jan-Paul
JP
Roovers
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D056887:Pelvic Organ Prolapse / Q000601:surgery*