title: Laparoscopic Pectopexy: A Biomechanical Analysis.
abstract: BACKGROUND
  Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in recent literature. Further improving this approach by reducing surgical time may decrease complication rates and patient morbidity. Since laparoscopic suturing is a time consuming task, we propose a single suture /mesh ileo-pectineal ligament fixation as opposed to the commonly used continues approach.
  
  
  METHODS
  Evaluation was performed on human non-embalmed, fresh cadaver pelves. A total of 33 trials was performed. Eight female pelves with an average age of 75, were used. This resulted in 16 available ligaments. Recorded parameters were ultimate load, displacement at failure and stiffness.
  
  
  RESULTS
  The ultimate load for the mesh + simplified single "interrupted" suture (MIS) group was 35 (± 12) N and 48 (± 7) N for the mesh + continuous suture (MCS) group. There was no significant difference in the ultimate load between both groups (p> 0.05). This was also true for displacement at failure measured at 37 (± 12) mm and 36 (±5) mm respectively. There was also no significant difference in stiffness and failure modes.
  
  
  CONCLUSIONS
  Given the data above we must conclude that a continuous suture is not necessary in laparoscopic mesh / ileo-pectineal ligament fixation during pectopexy. Ultimate load and displacement at failure results clearly indicate that a single suture is not inferior to a continuous approach. The use of two single sutures may improve ligamental fixation. However, overall stability should not benefit since the surgical mesh remains the limiting factor.
authors: Department of Gynecology and Obstetrics, Hospital Düren GmbH, Düren, Germany.
authors: A
authors: A
authors: Sauerwald
authors: Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany.|Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany.
authors: M
authors: M
authors: Niggl
authors: Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors: J
authors: J
authors: Puppe
authors: Department of Anatomy, RWTH Aachen University, Aachen, Germany.
authors: A
authors: A
authors: Prescher
authors: Department of Anatomy II, University of Cologne, Cologne, Germany.
authors: M
authors: M
authors: Scaal
authors: Dep. Ob/Gyn Hospitals Rhein-Kreis-Neuss, Faculty University of Witten/Herdecke, Witten, Germany.
authors: G K
authors: GK
authors: Noé
authors: Dep. Ob/Gyn Marienhospital Witten, Witten, Germany.
authors: S
authors: S
authors: Schiermeier
authors: Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany.|Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.
authors: M
authors: M
authors: Warm
authors: Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany.|Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany.
authors: C
authors: C
authors: Eichler
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery; D010388:Pelvis / Q000601:surgery*; D013526:Surgical Mesh; D013536:Suture Techniques; D016474:Weight-Bearing