Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon’s audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.
Related Content
Comparative outcomes of open versus laparoscopic sacrocolpopexy among medicare beneficiaries
Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure’s effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopically a...


Étude préliminaire sur la faisabilité de la double promontofixation robotique comparée à la voie cœlioscopique
Le but de notre étude a été de démontrer la faisabilité de la double promontofixation robot-assistée en la comparant à la voie cœlioscopique pure. Trente-six patientes ont été opérées d’une promontofixation antérieure et postérieure avec pose de deux bandelettes entre novembre 200...
Novel hybrid laparoscopic sacrocolpopexy for pelvic organ prolapse with a severe paravaginal defect
Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patient...


Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh
To evaluate the long-term outcomes of laparoscopic lateral suspension using mesh reinforcement for symptomatic posthysterectomy vaginal vault prolapse. We analyzed in a prospective cohort study all the women treated by laparoscopic lateral suspension with mesh for symptomatic vaginal vault prolap...
Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis of Comparative Studies
Surgery represents the mainstay of treatment for pelvic organ prolapse (POP). Among different surgical procedures, abdominal sacrocolpopexy (SC) is the gold standard for apical or multicompartmental POP. Research has recently focused on the role of robot-assisted sacrocolpopexy (RASC). To conduct...

Modified laparoscopic sacrocolpopexy with mesh for severe pelvic organ prolapse
To evaluate anatomic and sexual outcomes among patients with severe pelvic organ prolapse, defined as stage III or higher by Pelvic Organ Prolapse Quantification (POP-Q), who underwent modified laparoscopic sacrocolpopexy. Between March 2007 and December 2010, a prospective study in Beijing, Chin...
Implementation of a new procedure: laparoscopic versus robotic sacrocolpopexy
The purpose of this study was to compare the implementation process and the learning curves of laparoscopic and robotic-assisted laparoscopic sacrocolpopexy (LSC and RSC, respectively) for vaginal apex prolapse. A retrospective study of the first 40 LSC and first 40 RSC procedures performed at on...

Laparoscopic hysteropexy: a novel technique for uterine preservation surgery
In recent years uterine preservation surgery for pelvic organ prolapse has become more popular. Traditional operations such as vaginal hysterectomy do not address the underlying pathophysiology of poor connective tissue support, which may result in a higher incidence of recurrent prolapse. This v...
Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS)
ACCESS is a randomized comparative effectiveness trial enrolling patients at two academic teaching facilities UCLA (Los Angeles, CA) and Loyola University (Chicago, IL). The primary aim is to compare costs of robotic assisted versus pure laparoscopic abdominal sacrocolpopexy (RASC vs LASC). Follo...

Rectal Mesh Exposure Following Laparoscopic Sacrocolpopexy
We report a case of a 68 year old woman who presented with rectal bleeding 13 days after a laparoscopic sacrocolpopexy. Clinical examination and a rectoscopy found a rectal exposure of the posterior polyester mesh placed during the surgery. The patient underwent endorectal surgery to remove the e...