title: Comparison of complications and prolapse recurrence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse.
abstract: OBJECTIVE
  Our objective was to compare complications and prolapse recurrence between laparoscopic (L-USLS) and vaginal (V-USLS) uterosacral ligament suspensions.
  
  
  METHODS
  This is a retrospective study of USLS procedures performed at a large academic center from 2011 to 2014. Patient demographics, surgical data, complications, and prolapse recurrence of L-USLS and V-USLS were compared. Logistic regression identified predictors of operative time, complications, and prolapse recurrence.
  
  
  RESULTS
  There were 54 L-USLS and 119 V-USLS procedures with median follow-up of 21.5 weeks (IQR 9.3-50.8). Women undergoing L-USLS were less likely to have medical comorbidities and had less severe prolapse, but were more likely to report prior hysterectomy. L-USLS had longer operative times (190.1 ± 46.8 vs 172.7 ± 47.3 min, p = 0.03), but after correcting for concomitant procedures, the operative times of the two approaches were not significantly different (adjusted OR 1.00, 95%CI 0.99-1.00). There was no significant difference in complications between groups (24.1 % vs 21.8 %, p = 0.75). However, there were nonsignificant trends toward more ureteral injuries and suture removals following V-USLS. Postoperative POP-Q points of the groups did not differ, except for total vaginal length (TVL), which was longer after L-USLS (8.3 ± 1.1 cm vs 7.4 ± 1.2 cm, p < 0.001). 19 patients met the composite definition of prolapse recurrence, with no significant difference between groups (16.2 % vs 16 %, p = 0.98). After adjusting for preoperative prolapse stage, route was not a significant predictor of prolapse recurrence (adjusted OR 0.39, 95 % CI 0.12-1.30).
  
  
  CONCLUSIONS
  L-USLS has comparable clinical outcomes, with similar rates of complications and prolapse recurrence to the traditional vaginal approach.
authors.affiliation: Division of Urogynecology, Department of Obstetrics & Gynecology, West Penn Hospital, 4800 Friendship Ave., Pittsburgh, PA, 1522, USA.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Turner
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA, 15213, USA.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Lavelle
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA, 15213, USA. dr.jon.shepherd@gmail.com.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Shepherd
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013537:Sutures / Q000009:adverse effects; D014513:Ureter / Q000293:injuries; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Minimally invasive surgery; Perioperative complications; Uterosacral ligament suspension; Vaginal prolapse