title: Combined sacrospinous hysteropexy and cystopexy using a single anterior incision.
abstract: OBJECTIVE
  To evaluate the safety, efficacy, and feasibility of a minimally invasive vaginal approach for treating advanced utero-vaginal prolapse.
  
  
  METHODS
  A prospective study enrolled consecutive patients attending the Gynecology and Obstetrics Department, Turin University for treatment of Pelvic Organ Prolapse Quantification (POP-Q) stage III of higher symptomatic utero-vaginal prolapse between February 1, 2013 and November 30, 2014. Participants underwent a combined sacrospinous hysteropexy and cystopexy procedure using a single anterior vaginal incision. Surgical procedures were performed by one of two surgeons, either an experienced senior surgeon or a resident surgeon under supervision. POP-Q staging, patient symptoms, and quality of life were evaluated before and after surgery.
  
  
  RESULTS
  The present study enrolled 42 patients and 19 (45%) were discharged on the first post-operative day. The mean operating time was 40.5±10.6minutes and there was no significant difference in operating time between the two surgeons. With an average follow-up duration of 13months, significant post-surgical improvements were recorded across both POP-Q anterior (P<0.001) and apical (P<0.001) domains, and in both prolapse impact (P<0.001) and urinary impact (P=0.001) quality-of-life measures; one apical recurrence and no major complications were recorded.
  
  
  CONCLUSIONS
  Combined sacrospinous hysteropexy and cystopexy through a single incision appears to be a safe and efficacious procedure that was relatively easy for surgeons to learn and resulted in a fast post-surgical recovery.
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Petruzzelli
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Chiadò Fiorio Tin
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cosma
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy. Electronic address: gemellanna@yahoo.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Garofalo
authors.affiliation: Gynecology and Obstetrics, Department of Surgical Sciences, City of Health and Science, University of Torino, Torino, Italy.
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007558:Italy; D008022:Ligaments; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Cystopexy; Pelvic organ prolapse; Sacrospinous hysteropexy; Sacrospinous ligament fixation; Uterus preservation