UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

LATERAL SUSPENSION PROCEDURES FOR PELVIC ORGAN PROLAPSE: CURRENT LITERATURE AND STANDART TECHNIQUE APPROACH

Sertaç Ayçiçek

Gazi Yaşargil Training and Research Hospital, Department of Gynecology and Obstetrics, Diyarbakır, Türkiye

Ayçiçek S. Lateral Suspension Procedures for Pelvic Organ Prolapse: Current Literature and Standart Technique Approach. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.277-286.

ABSTRACT

Apical pelvic organ prolapse is the condition in which the vaginal apex (cervix or vaginal vault) prolapses downward from its normal anatomic position within the vaginal canal and is often associated with anterior (cystocele) or posterior (rectocele/enterocele) vaginal wall prolapse. This condition causes symptoms such as a feeling of pressure, urinary and defecation problems, which can seriously affect the quality of life of women. Lateral suspension procedures offer effective and minimally invasive options for treating this complex condition, particularly for apical and anterior vaginal prolapse. In the current literature, these techniques stand out with laparoscopic, robotic and V-NOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery) approaches.

The standard surgical technique for lateral suspension is essentially fixation of the vaginal apex or cervix (if hysterectomy has not been performed) to the peritoneum on the lateral abdominal wall by means of a synthetic mesh. This fixation provides support by returning the pelvic organs to their anatomical position like a new ligament. This approach has become widespread thanks to the pioneering work of Dr. B. Dubuisson since the early 2000s. Dubuisson and her team have made important publications demonstrating the safety and efficacy of laparoscopic lateral suspension, demonstrating that this technique can be an alternative to traditional sacrocolpopexy. Their initial series has brought a new dimension to minimally invasive pelvic floor surgery by offering the potential to reduce postoperative pain and shorten recovery time.

Today, laparoscopic lateral suspension is a popular procedure performed through small incisions using a camera and surgical instruments. The surgeon binds the vaginal apex or cervix with a mesh and fixes it to the peritoneum in the lateral pelvic wall. This minimally invasive approach offers less pain, shorter hospital stay and faster recovery compared to traditional open surgery. Robotic lateral suspension adds additional benefits to the advantages of laparoscopic surgery, such as 3D imaging, increased mobility and tremor elimination. This allows the surgeon to perform more precise dissection and suturing and may be preferred especially in cases of complex or recurrent prolapse. One of the newest approaches, V-NOTES lateral suspension, is a technique that is performed through natural vaginal openings and does not require any incision in the abdominal wall. Surgical instruments are inserted through the vagina into the abdominal cavity to repair the prolapse. This method is attractive because it leaves no visible scarring, potentially less pain and faster recovery. However, V-NOTES lateral suspension is still an emerging technique and more data on long-term success rates are needed.

The concept of lateral suspension, pioneered by Dubuisson, is constantly evolving with minimally invasive surgical techniques and has an important place in the treatment of pelvic organ prolapse in women. The surgeon’s experience, the specific condition of the patient and the degree of prolapse play a critical role in determining the most appropriate approach.

Keywords: Apical pelvic organ prolapse; Lateral suspension; Minimal invasive surgery

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