Sevilla IÑ, et al. J Gynecol Oncol. 2018 Aug;30:e63. https://doi.org/10.3802/jgo.2019.30.e63

Background: Laparoscopic sacropexy (SCL) is the gold standard technique for the correction of apical pelvic organ prolapse (POP). However, other easier laparoscopic techniques, such as laparoscopic lateral suspension (LLS), have become popular. Methods: We conducted a multicenter randomized study of patients undergoing laparoscopic repair of apical and anterior prolapse. Patients were randomized into two groups: LLS vs. SCL. A non-inferiority study was proposed, in which the null hypothesis was that the difference in the proportion of therapeutic failures among women who undergo LLS compared to SCL is ≥15%. It was necessary to include 182 participants to detect a risk difference of 15% after one year with a statistical power of 0.80. Results: We recruited 176 women, of whom 106 patients underwent surgery with a follow-up between 1 and 12 months. There were no differences in basal characteristics. Regarding physical examination, there were no differences at stages III-IV in the POP-Q or the symptom scales in both groups. Concerning the post-surgical results, there were no failures detected in the physical examination in any group. There were no differences in the points of the POP-Q, the symptom scales, or the body image scale. We only found significant differences in the operative time, which was shorter for the LLS. Conclusions: Although these are preliminary results, since the sample includes 106 patients and the follow-up time is a limited period at the moment, we did not find any post-surgical differences between the two techniques. However, it will be necessary to complete the trial to draw relevant conclusions.

Background: Laparoscopic sacropexy (SP) is widely recognized as the gold standard for addressing apical pelvic organ prolapse. Nonetheless, alternative laparoscopic procedures, such as pectopexy (PP) and Dubuisson’s laparoscopic lateral suspension (LLS), have gained traction due to their relative technical simplicity. Objective: This study aims to assess both the preoperative characteristics and surgical outcomes in a cohort-based comparative study of three minimally invasive apical prolapse surgeries. Methods: We conducted a prospective, single-center study involving patients treated laparoscopically for apical prolapse. The surgical approaches compared include: sacropexy (SP); laparoscopic lateral suspension following Dubuisson’s technique (LLS), and pectopexy (PP). Results: A total of 180 patients underwent surgery: 115 with SP, 33 with LLS, and 32 with PP. While some differences were observed in patient profiles—such as a lower average BMI and more advanced prolapse stages (III and IV) in the SP group—the rates of surgical failure (evaluated through apical recurrence, need for reintervention, pessary use, and persistent symptoms) did not differ statistically between groups. In terms of anatomical outcomes, only the total vaginal length (TVL) was notably longer in the SP group. A clinically important finding was the substantially reduced operative time with the alternative methods, particularly LLS, which took less than half the duration required for SP, without any increase in intraoperative complication rates. Conclusions: Further research, particularly well-designed randomized multicenter trials, is essential to establish the relative efficacy of the alternative approaches (LLS and PP) compared with the current gold standard, sacropexy.

Background: Laparoscopic sacropexy (SCL) is the gold standard technique for the correction of apical pelvic organs prolapse (POP). However, other easier laparoscopic techniques such as laparoscopic lateral suspension (LLS) have become popular. Methods: A multicentre randomized study of patients undergoing laparoscopic repair of severe apical and anterior prolapse. Patients were randomized into 2 groups: LLS vs SCL. A non-inferiority study is proposed in which the null hypothesis is that the difference in the proportion of therapeutic failures among women who undergo LLS compared to SCL is ≥15%. It will be necessary to include 182 participants to detect a risk difference of 15% (at one year with a statistical power of 0.80). Results: we have recruited 176 women, and 106 patients have been operated with a follow-up between 1 and 12 months. There were not differences in basal characteristics. Regarding physical examination, there were no differences in stages III-IV in the POP-Q neither the symptom scales in both groups. Concerning post-surgical results there were no failures in the physical examination in any group. There were no differences in the points of the POP-Q neither in the symptom scales or Body image scale. We only found significant differences in the operative time, being shorter for the LLS. Conclusion: Although these are preliminary results, since the sample is 100 patients and the follow-up time is short, at the moment, we didn’t find post-surgical differences between the 2 techniques. However, it is necessary to complete the trial to draw relevant conclusions.

Background: to prove the effectivity of fertility-sparing procedures in early-stage ovarian cancer by assessing pregnancy rates and obstetrical outcomes. Methods: we performed a retrospective multicenter study among 55 Spanish hospitals, collecting patients from 18 to 40 years old with diagnosis of early-stage ovarian cancer, epithelial (EOC) or non-epithelial (non-EOC), from January 2010 to December 2019. Data on the use of assisted reproductive techniques, pregnancy attempts and obstetrical outcomes were collected. Results: a total of 150 patients met inclusion criteria, 70 (46.6%) EOC and 80 (53.4%) non-EOC. Pregnancy attempts were reported in 51 (34%) patients, with 42 (28%) patients carrying the pregnancy to term. Among them, 30 (71.4%) underwent surgery alone and 12 (28.6%) had additional postoperative chemotherapy. A total of 32 (76.1% patients) had spontaneous pregnancies and 10 (23.9%) required in vitro fertilization. There was only one (2.4%) complication reported. Vaginal delivery was reported in twenty-nine (69%) patients and cesarean section in five (11.9%) patients. Conclusions: fertility-sparing management for ovarian cancer seems to be an option with proven good pregnancy rates and low complications. The selection of patients must consider strict criteria in order to maintain a good prognosis.

Background: Laparoscopic sacropexy (SP) is widely recognized as the gold standard for addressing apical pelvic organ prolapse. Nonetheless, alternative laparoscopic procedures, such as pectopexy (PP) and Dubu-isson’s laparoscopic lateral suspension (LLS), have gained traction due to their relative technical simplici-ty. Objective: This study aims to assess both the preoperative characteristics and surgical outcomes in a Cohort-Based Comparative Study of Three Minimally Invasive Apical Prolapse Surgeries. Methods: We conducted a prospective, single-center study involving patients treated laparoscopically for apical prolapse. The surgical approaches compared include: Sacropexy (SP); Laparoscopic lateral suspension following Dubuisson’s technique (LLS) and Pectopexy (PP). Results: A total of 180 patients underwent surgery: 115 with SP, 33 with LLS, and 32 with PP. While some differences were observed in patient profiles—such as a higher average BMI and more advanced prolapse stages (III and IV) in the SP group, the rates of surgical failure (evaluated through apical recurrence, need for reintervention, pessary use, and persistent symptoms) did not differ significantly between groups. In terms of anatomical outcomes, only the total vaginal length (TVL) was notably longer in the SP group. A significant finding was the substantially reduced operative time with the alternative methods, particularly LLS, which took less than half the duration required for SP, without any increase in intraoperative complication rates. Conclusion: Further research, particularly well-designed randomized multicenter trials, is essential to establish the relative efficacy of the alternative approaches (LLS and PP) compared with the current gold standard, sacropexy.