Laparoscopic Versus Abdominal Sacrocolpopexy: A Randomized, Controlled Trial

J Urol. 2016 Jul;196(1):159-65. doi: 10.1016/j.juro.2015.12.089. Epub 2016 Jan 11.

Abstract

Purpose: Few randomized, controlled trials have compared standard abdominal sacrocolpopexy and the laparoscopic approach. We tested the hypothesis that laparoscopic sacrocolpopexy could compete with abdominal sacrocolpopexy for pelvic organ prolapse repair.

Materials and methods: This randomized, controlled trial was done to compare laparoscopic sacrocolpopexy and abdominal sacrocolpopexy for pelvic organ prolapse repair in women referred to our tertiary Department of Urology for symptomatic stage 2 or greater pelvic organ prolapse. The primary outcome was quantitative evaluation by the POP-Q (Pelvic Organ Prolapse Quantification) system. Cure was defined as prolapse stage 1 or less, point C/D -5 or less at the apex and at least 7 cm total vaginal length. Secondary outcomes were the complication rate, operative time, intraoperative blood loss, hospital stay and PGI-I (Patient Global Impression of Improvement) scores. The Kaplan-Meier estimator with the log-rank test was used to estimate pelvic organ prolapse recurrence-free survival rates.

Results: A total of 200 patients were eligible for study. We compared 60 and 61 patients treated with abdominal and laparoscopic sacrocolpopexy, respectively. At a mean followup of 41.7 months the cure rate was of 100% for both approaches. Kaplan-Meier curves showed that overall pelvic organ prolapse recurrence-free survival was longer following the open approach. Patients treated with laparoscopic sacrocolpopexy showed significantly earlier recurrence (p = 0.030), mostly in the first 12 months after surgery. When evaluating the different compartments, a statistically significant difference was observed between the laparoscopic and abdominal approaches for anterior compartment descensus (11 vs 1, p = 0.004). Statistical results had high internal validity but may not be applicable to other populations or settings.

Conclusions: Laparoscopic sacrocolpopexy provides outcomes as good as those of abdominal sacrocolpopexy for anatomical correction but not for anterior pelvic organ prolapse.

Keywords: gynecologic surgical procedures; laparoscopy; outcome and process assessment (health care); pelvic organ prolapse; vagina.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / surgery
  • Adolescent
  • Adult
  • Aged
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Kaplan-Meier Estimate
  • Laparoscopy*
  • Middle Aged
  • Pelvic Organ Prolapse / diagnosis
  • Pelvic Organ Prolapse / surgery*
  • Prospective Studies
  • Treatment Outcome
  • Vagina / surgery
  • Young Adult