Int Urogynecol J DOI 10.1007/s00192-014-2398-6

CLINICAL OPINION

The challenge of implementing laparoscopic sacrocolpopexy Jan Deprest & Ladislav Krofta & Frank Van der Aa & Alfredo L. Milani & Jan Den Boon & Filip Claerhout & Jan-Paul Roovers

Received: 16 September 2013 / Accepted: 7 April 2014 # The International Urogynecological Association 2014

Abstract Vaginal-vault prolapse is effectively treated using sacrocolpopexy (SCP). A randomized trial demonstrated that it can be performed as effectively via laparoscopy (LSCP) as via laparotomy and with less morbidity. This evidence begs the question of how units offering abdominal sacrocolpopexy will implement LSCP. Several limitations need to be overcome. LSCP initially requires longer operating time; however, that decreases with surgeon experience. To decrease operation time, suture training can be implemented ahead. Following a 15-h suturing lab, trainees achieved comparable operation times after 30 cases. Dissection is another critical timeconsuming step and is difficult to model. Proficiency is more dependent on patient characteristics, though this component is poorly studied. One experience showed it takes 60 procedures J. Deprest (*) : F. Van der Aa Department Development and Regeneration, Faculty of Medicine & Pelvic Floor Unit, University Hospitals, KU Leuven, 3000 Leuven, Belgium e-mail: [email protected] L. Krofta Department of Obstetrics and Gynaecology, 1st Medical Faculty of Charles University and Hospital Na Bulovce, Prague, Czech Republic F. Claerhout Department of Obstetrics and Gynaecology, St Lucas Hospital, Bruges, Belgium J.200 consecutive cases from the first case onward. MOA showed that operation time declined rapidly in the first 30 cases, reaching a steady state after 90 cases [14]. These observations question the relevance of conclusions of earlier, smaller studies (Table 3). CUSUM analysis showed adequate learning (no need for conversion to laparotomy, absence of anatomical failure and major complications) after 60 cases, the point at which inadequacies drop to

The challenge of implementing laparoscopic sacrocolpopexy.

Vaginal-vault prolapse is effectively treated using sacrocolpopexy (SCP). A randomized trial demonstrated that it can be performed as effectively via ...
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