A Novel Technique for Pelvic Organ Prolapse Repair: Cervical Thread Suspension with Minimal Mesh
Prof. Yasukuni Yoshimura (1)
(1) Showa University Yokohama Nothern Hospital, Yokohama, Japan
Although the use of mesh to treat POP is controversial, transvaginal mesh surgery has remained to be one of the primary options for POP repair in Japan. To reduce complication, it is believed that minimum amount of mesh should be used. Here, we report a new technique, “cervical thread suspension” with minimal mesh.
11 POP women were operated. The standard vertical incision is made on the anterior vaginal wall. Both sacrospinous ligaments (SSLs) are identified and palpated by the anterior approach on each side. A self-made plastic sheath is inserted onto the SSL. By using this sheath, the surface of the SSL is clearly visible. Capio™ is inserted through this sheath and fired under direct vision and the suture ( nonabsorbable 0 ) is retrieved. The small square mesh is attached to the end of the retrieved suture to avoid “cheese-wire phenomenon” on the SSL. The same procedure is performed on the other side. A 4 x 5cm oval shaped mesh is placed on the bladder wall, and fixed to vaginal wall and cervix. Sharp needles are then attached to the Capio sutures on both sides, and by stitching the cervix and mesh on each side and pulling the sutures together on the front side of the cervix, the cervix is pulled back to the SSL.
Mean operation time was 41 ± 18 minutes. There were no intraoperative complications. Median follow-up time was 11.2 months. There was significant improvement in POP-Q points, urine flow rate, post voiding residual and QOL in all patients after the treatment. No postoperative complications were noted except one case of de novo SUI.
In TVM procedure, apical support is generally made with a “mesh arm.” But there is no need for this support to be made with a mesh. This novel technique would potentially reduce mesh size, therefore reducing risk of mesh-related complications. Our short-term results suggested that the technique is safe and highly effective method.