TY - JOUR
T1 - Sacrocolpopexy with Concomitant Total vs Supracervical Hysterectomy
T2 - Functional Support Comparisons in Cadavers
AU - Maldonado, Pedro Antonio
AU - Norris, Kyle P.
AU - Florian-Rodriguez, Maria E.
AU - Shah, Nemi M.
AU - Wai, Clifford Y.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure of functional anatomic support in human cadavers. Methods Supracervical hysterectomy was performed on unembalmed cadaver specimens, followed by ASC attaching polypropylene mesh to the posterior cervix/vagina only and then the anterior and posterior cervix/vagina. Using a metal bolt placed through the cervix tied to a filament passing through a fixed pulley system, successive weights of 0.5 to 3.0 kg were added to provide increasing loads on the apex (cervix), and the distances traversed by the apex were recorded. The same process was then repeated in each specimen after removal of the cervix (with vaginal cuff closure). One-way and repeated-measures analysis of measure was used for between-group and within-group comparisons, respectively, with P ≤ 0.05 considered statistically significant. Results Eight cadavers were examined. At lower weight loads, pulling distances in the 4 groups examined were similar and were not significantly different with the presence or absence of the cervix. At weight loads of 2.5 kg or greater, we noted a trend of increased pulling distances when posterior mesh only was used vs when anterior/posterior mesh was placed, although this difference was not significant. Interestingly, there was tearing of the vaginal wall or partial separation of mesh/sutures attachments to the vagina noted in 3 specimens. Conclusions This study showed no differences in the ability of the cervix (after supracervical hysterectomy) compared with the vaginal cuff (after total hysterectomy) to resist downward traction of successive weights after ASC. Clinical trials are necessary to correlate these findings with prolapse recurrence rates and patient satisfaction following these procedures.
AB - This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure of functional anatomic support in human cadavers. Methods Supracervical hysterectomy was performed on unembalmed cadaver specimens, followed by ASC attaching polypropylene mesh to the posterior cervix/vagina only and then the anterior and posterior cervix/vagina. Using a metal bolt placed through the cervix tied to a filament passing through a fixed pulley system, successive weights of 0.5 to 3.0 kg were added to provide increasing loads on the apex (cervix), and the distances traversed by the apex were recorded. The same process was then repeated in each specimen after removal of the cervix (with vaginal cuff closure). One-way and repeated-measures analysis of measure was used for between-group and within-group comparisons, respectively, with P ≤ 0.05 considered statistically significant. Results Eight cadavers were examined. At lower weight loads, pulling distances in the 4 groups examined were similar and were not significantly different with the presence or absence of the cervix. At weight loads of 2.5 kg or greater, we noted a trend of increased pulling distances when posterior mesh only was used vs when anterior/posterior mesh was placed, although this difference was not significant. Interestingly, there was tearing of the vaginal wall or partial separation of mesh/sutures attachments to the vagina noted in 3 specimens. Conclusions This study showed no differences in the ability of the cervix (after supracervical hysterectomy) compared with the vaginal cuff (after total hysterectomy) to resist downward traction of successive weights after ASC. Clinical trials are necessary to correlate these findings with prolapse recurrence rates and patient satisfaction following these procedures.
KW - posterior mesh
KW - sacrocolpopexy
KW - supracervical hysterectomy
KW - total hysterectomy
UR - http://www.scopus.com/inward/record.url?scp=85065075381&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065075381&partnerID=8YFLogxK
U2 - 10.1097/SPV.0000000000000532
DO - 10.1097/SPV.0000000000000532
M3 - Article
C2 - 29219861
AN - SCOPUS:85065075381
SN - 2151-8378
VL - 25
SP - 213
EP - 217
JO - Female Pelvic Medicine and Reconstructive Surgery
JF - Female Pelvic Medicine and Reconstructive Surgery
IS - 3
ER -