Editorial board editor-in-chief

Table 1.
Demographics, previous surgeries
Group A
n= 12
Group B
n= 6
Group C
n= 10
Age (mean)
46,83
52,83
51,90
Menopausal status
Premenopausal
Postmenopausal with HRT
Postmenopausal without HRT
3
6
3
0
2
4
2
1
7
Prior hysterectomy
or urogyne-cologic
or pelvic surgery
0
0
10
Parity
1
2
3
5
6
1
1
5
0
2
6
2
Preoperative prolapse POPQ
Stage I
Stage II
Stage III
0
9
3
0
4
2
4
6
0
Urinary incontinence
Stress
2
0
0
Descriptive statistics of measurable variables are shown in 
Table 2 and 3. Mean patient’s age was 49,93 years old, mean 
operation time 55,18 minutes (min) and mean estimated blood 
loss 118,04 milliliters (mL).

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Laparoscopic colpopexy technique…
Table 2. 
Descriptive statistics of measurable variables (age, mean operation time and estimated blood loss)
Mean
SD
Minimum
Maximum
N
Age
49,93
4,19
42,00
58,00
28,00
A (for LSH)
46.83
2.75
42,00
51,00
12,00
B (for TLH)
52,83
1,83
51,00
55,00
6
C (for after_hyster)
51,90
4,33
45,00
58,00
10
mean operation time (min)
55,18
7,63
48,00
70,00
28,00
A (for LSH)
51,50
2.96
48,00
57,00
12,00
B (for TLH)
68,83
1,32
67,00
70,00
6
C (for after_hyster)
51,40
2,17
49,00
55,00
10
mean estimated blood loss (mL)
118,04
22,66
85,00
160,00
28,00
A (for LSH)
120,00
12,06
100,00
140,00
12,00
B (for TLH)
144,16
15,62
120,00
160,00
6
C (for after_hyster)
100,00
20,13
85,00
159,00
10
mean length of hospital stay
3,10
0,46
2,45
3,29
28
A (for LSH)
2.16
0,38
2,00
3,00
12
B (for TLH)
3.33
0,51
3,00
4,00
6
C (for after_hyster)
3.20
0,42
3,00
4,00
10
Table 3. 
Descriptive statistics of variables eg. “Operation type”, “POPQ”, “Diagnosis”, “pain at the level of fascia after 1 week”, 
“Parity”
Value
Frequency
Percent of Total
Operation type*
A (LSH)
12
42,86
B (TLH)
6
21,43
C (after_hyster)
10
35,71
POPQ**
3
5
17,86
2
19
67,86
1
4
14,29
Diagnosis***
0
10
35,71
1
9
32,14
2
9
32,14
pain at the level of fascia after 1 week****
0
22
78,57
1
6
21,43
Parity (number of deliveries)*****
1
8
28,57
2
17
60,71
3
3
10,71
* Operation type: LSH – laparoscopic subtotal hysterectomy; TLH – total laparoscopic hysterectomy; after hysterectomy
** POPQ (pelvic organ prolaps quantiication): 1 stage; 2 stage; 3 stage
*** Diagnosis: 0 – prolapsus; 1 – Mayoma; 2 – abnormal bleeding
**** Pain at the level of fascia after 1 week: 1 – pain; 0 – without pain
***** Parity: 1 – once, 2 – twice; 3 – for three times delivered

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Laparoscopic colpopexy technique…
The Pearson Chi-Square Test was used for assessing de-
pendences in contingency tables between particular immeasur-
able variables (Table 4). 
Table 4.
P-values calculated on the basis of the Pearson
Chi-Square Test
Partity
Pain at the 
level of facia 
after 1 month
Diagnosis POPQ
Operation type
0.475
0.912
0.001
0.035
Partity
-
0.124
0.687
0.065
Pain at the level of 
fascia after 1 week
-
-
0.999
0.505
Diagnosis
-
-
-
0.085
Details for variables with statistical signiicance:
Table 4a. 
Operation type – Diagnosis
Operation type
diagnosis
Total
%
0
1
2
LSH
0 
0.00
8 
28.57
4 
14.29
12 
42.86
TLH
0 
0.00
1 
3.57
5 
17.86
6 
21.43
after_hyster
10 
35.71
0 
0.00
0 
0.00
10 
35.71
Total
10 
35.71
9 
32.14
9 
32.14
28 
100.00
There were found statistical signiicant dependences between 
“Operation type” and “Diagnosis” (p=.001, α=.05) and “Opera
-
tion type” and POPQ (p=.035, α=.05). Diagnosis of prolapsus 
indicated LSH procedure in 28,57% cases, vs abnormal vaginal 
bleeding for TLH in 17,86% (Table 4a).
Table 4b. 
Operation type – POPQ
Operation type
POPQ
Total
%
1
2
3
LSH
0 
0.00
9 
32.14
3 
10.71
12 
42.86
TLH
0 
0.00
4 
14.29
2 
7.14
6 
21.43
after_hyster
4 
14.29
6 
21.43
0 
0.00
10 
35.71
Total
%
4 
14.29
19 
67.86
5 
17.86
28 
100.00
POPQ 2 indicated LSH procedure in 32,14%, vs 14,29% for 
TLH and 21,43% after hysterectomy (Table 4b).
Table 5. 
P-values calculated on the basis of the Kruskal-Walis Test 
Age*
Mean operation 
time*
Mean length of 
hospital stay*
Mean estimated 
blood loss*
POPQ
0.34
0.56
0.67
0.13
Pain at the level of fascia after1 week
0.48
0.34
1
0.29
Diagnosis
0.0028
0.0111
0.0047
0.046
Parity
0.83
0.58
0.39
0.32
Operation type
0.0017
0.0008
0.001
0.0007
* variable does not follow a speciied theoretical – normal distribution
Statistical signiicance among mean values of quantitative 
variables as: “age” (p=.0017, α=.05), and qualitative – “Operation 
type” variable is observed (Table 5). It suggests that the age and 
the operation type are correlated and mean age for LSH was 
46,83, vs TLH 52,83, vs after hysterectomy 51,90.
Mean operation time (p=.0008, α=.05) depended from opera
-
tion type (mean time for all operations was 55,18 min vs 51,50 
for LSH vs 68,83 min for TLH and 51,40 for after hysterectomy). 
We found statistically signiicant correlation between operation 
type and mean length of hospital stay (p=.001, α=.05), for LSH it 
was 2,16 days vs 3,33 for TLH and for 3,20 after hysterectomy. 
Mean estimated blood loss (p=.0007, α=.05) and operation type 
were statistically signiicant, with mean value for LSH 120 mL vs 
144,16 mL for TLH and 100 mL for after hysterectomy (Table 5).
Discussion
As with all of the other apical support procedures, it is dificult to 
quantify the success rates because of wide variation in outcome 
measures and deinitions used for success.
Some studies focus on support of the vaginal apex, while 
others consider overall vaginal support. This is more complicated 
for abdominal repairs, in which posterior vaginal wall support pro-
cedures are often deferred, and there is a variation in concomitant 
procedures for anterior wall support and urinary incontinence.
Most of the studies use synthetic mesh grafts, which offer 
durable repairs. Several characteristics of synthetic meshes 
appear to affect the prevalence of erosion, including pore size, 
ilament type, and weave. The monoilament, macroporous soft 
meshes (polypropylene) seem to be the best for use in colpopexy. 
A recent randomized control trial provides level I evidence that 
allogenic fascia lata is inferior to synthetic mesh (68% versus 
91% respectively at 1 year) for sacral colpopexy [10].

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Laparoscopic colpopexy technique…
Sacral colpoperineopexy is a modiication of sacral colpo
-
pexy aimed at correcting a combination of conditions, includ-
ing apical prolapsed, rectocele, and perineal descent. During 
ascral colpoperineopexy, a continuous graft is placed from the 
anterior longitudinal ligament to the perineal body. This can be 
accomplished either through a total abdominal approach or 
a combined abdominal and vaginal procedure. Cundiff et al. 
displayed good anatomical support of the vaginal apex, poste-
rior wall, and perineum over short-term follow-up for 19 women 
undergoing sacral colpoperineopexy [11]. Defecatory dysfunction 
symptoms completely resolved in 66% of patients. Sullivan et 
al reported outcomes for a slightly different variation of sacral 
colpoperineopexy involving attachment of Marlex mesh to the 
perineal body using a needle carrier [12]. The failure rate was 
25% and the mesh erosion rate was 5% for 205 patients with 
up to 10-year follow-up.
Colombo and Milani performed a retrospective case-control 
study using 62 cases of sacrospinous ligament ixation and 62 
matched controls undergoing modiied McCall culdoplasty [13]. 
There was no statistically signiicant differences in postopera
-
tive objective support, even for women with procidentia. The 
authors concluded that McCall culdoplasty was equally efica
-
cious as sacrospinous ligament suspension with less morbidity, 
and sacrospinous suspension should no longer be considered 
as a treatment in patients with uterovaginal prolapsed.
Laparoscopic sacral colpopexy is an attempt to make sacral 
colpopexy less invasive with a quicker recovery, similar to vaginal 
surgery. Complication rates, operative time, duration of hospital
-
ization, recovery time, postoperative recovery, and costs have 
not been prospectively compared for laparoscopic and open 
sacral colpopexy.
There is no available literature for laparoscopic colpopexy 
modiication described in the article. This technique, as a whole, 
allows a complete anatomical repositioning of the pelvic organs 
that inluence their various functions and prevent any possible 
new prolapsed.
Laparoscopy is a viable approach for the surgical treatment 
of urogenital prolapse. It is a minimally invasive surgery that 
requires a short hospital stay. Few complications were observed. 
Laparoscopic colpopexy with the addition of mesh is particularly 
indicated for women with vaginal vault prolapse who would like 
to improve their quality of life. This unique approach can be used 
concomitantly with LSH or TLH. It is also helpful for patients 
with a history of hysterectomy, for whom laparoscopy will allow 
minimal postoperative pain and shorter hospital stay. 
The obvious weaknesses of our report include the small 
patient number and the short-term follow-up.
Conclusion
The large number of corrective surgical techniques described in 
the literature for genitor-urinary prolapsed only proves that there 
is still no consensus on this issue. 
We believe that the positive results of this minimally invasive 
procedure could be ascribed to the use of the typical laparoscopy 
technique. It must, however, be performed by an experienced 
surgeon.
References
1. Olsen A.L., Smith v.J., Bergstrom J.O., Colling J.C., Clark 
A.L. (1997): Epidemiology of surgically managed pelvic or
-
gan prolpase and urinary incontinence. Obstet Gynecol 89, 
pp. 501-6.
2. Nezhat C.H., Nezhat F., Nezhat C. (1994): Laparoscopic 
sacral colpopexy for vaginal vault porolapse. Obstet Gyne
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col 84, pp. 885-888.
3. Nygaard I.E., McCreery R., Brubaker L. et al. (2004): Ab
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dominal sacrocolpopexy: a comprehensive review. Obstet 
Gynecol 104, pp. 805-823.
4. Culligan P.J., Murphy M., Blackwell L. et al. (2002): Long-
term success of abdominal sacral colpopexy using synthe-
tic mesh. AM J Obstet Gynecol 187, pp. 1473-1480.
5. Cundiff G.W., Feiner D. (2004): Evaluation and treatment of 
women with rectocele: focus on associated defecatory and 
sexual dysfunction. Obstet Gynecol 104, pp. 1403-1421.
6. Scott R.J., Garely A.D., Greston W.M. et al. (1998): Para
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vaginal repair of lateral vaginal wall defects by ixation to 
the ischial periostium and obturator membrane. AM J Ob
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stet Gynecol 179, pp. 1436-1445.
7. De vita, Araco, Gravante, Sesji, Piccione (2008): vaginal 
reconstructive surgery for severe pelvic organ prolapses: 
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ses. Eur J of Obstet&Gynecol and Reproductive Biology 
139, pp. 245-251.
8. Davila G.W., Ghoniem G.M., Kapoor D.S. et al. (2002): 
Pelvic loor dysfunction management practice patterns: 
a survey of members of the International Urogynecologi-
cal Association. Int Urogynecol J Pelvic Floor Dysfunct 13, 
pp. 319-325.
9. Bump R.C., Mattiasson A., Bo K., Brubaker L.P., DeLancey 
J.O., Klarskov P., Shull B.L., Smith A.R. (1996): The stan
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darization of terminology of female poelvic organ prolapse and 
pelvic loor dysfunction. Am J Obstet Gynecol 175, pp. 10-17.
10. Culligan P.J., Blackwell L., Goldsmith L.J. et al. (2005): 
A rando-mized controlled trial comparing fascia lata and 
synthetic mesh for sacral colpopexy. Obstet Gynecol 106, 
pp. 29-37.
11. Cundiff G.W., Harris R.L., Coats K. et al. (1997): Abdominal 
sacral colpoperineopexy: A new approach for correction of 
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ciated with vaginal vault prolapsed. Am J Obstet Gynecol 
177, pp. 1345-1355.
12. Sullivan E.S., Longaker C.J., Lee P.Y.. (2001): Total pelvic 
mesh repair. A ten-year experience. Dis Colon Rectun 44, 
pp. 857-863.
13. Colombo M., Milani R. (1998): Sacrospinous ligemant ixa
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ectomy for advanced uterovaginal prolapsed. Am J Obstet 
Gynecol 179, pp. 13-20.
The authors have no commercial, property, or inancial inter
-
est in the products or companies described in this article.
Corresponding author: Klaudia Stangel-Wójcikiewicz MD, 
PhD, Gynecology and Oncology Department, Collegium Medicum 
Jagiellonian University, Kopernika 23, 31-051 Kraków, Poland
E-mail: [e-mail]

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BIO-ALGORITHMS AND MED-SYSTEMS
JOURNAL EDITED BY JAGIELLONIAN UNIVERSITY – MEDICAL COLLEGE
Vol. 7, No. 13, 2011, pp. 49-56