Table Of ContentLaparoscopic Urogynaecology
Laparoscopic Urogynaecology
Principles and Practice
Edited by
Christian Phillips
Hampshire Hospital, Basingstoke
Stephen Jeffery
Netcare Christiaan Barnard Memorial Hospital
Barry O’Reilly
Cork University Maternity Hospital
Marie Fidela R. Paraiso
Professor of Obstetrics, Gynecology, and Reproductive Biology,
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and
Vice Chair, OBGYN and Women’s Health Institute
Cleveland Clinic Board of Governors
Cleveland, OH
Bruno Deval
Geoffroy St Hilaire Hospital, Paris
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Names: Phillips, Christian Hambro, editor. | Jeffery, Stephen (Stephen
Trembarth), editor. | O'Reilly, Barry, MD, editor. | Paraiso, Marie
Fidela R., editor. | Deval, Bruno, editor.
Title: Laparoscopic urogynecology : principles and practice / edited by
Christian Phillips, Stephen Jeffery, Barry O'Reilly, Marie Fidela R.
Paraiso, Bruno Deval.
Description: Cambridge, United Kingdom ; New York, NY : Cambridge
University Press, 2021. | Includes bibliographical references and index.
Identifiers: LCCN 2021050294 (print) | LCCN 2021050295 (ebook) | ISBN
9781009123174 (hardback) | ISBN 9781009123174 (ebook)
Subjects: MESH: Gynecologic Surgical Procedures | Urologic Surgical
Procedures | Laparoscopy
Classification: LCC RG104.7 (print) | LCC RG104.7 (ebook) | NLM WP 660 |
DDC 618.1/0597–dc23/eng/20211101
LC record available at https://lccn.loc.gov/2021050294
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ISBN 978-1-009-12317-4 Hardback
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Contents
List of contributors vii
Section 1: Basic Principles in Laparoscopic 12 Laparoscopic Sacrohysteropexy: Oxford Technique:
Procedure Steps and Evidence 92
Urogynaecology
Matthew Izett-Kay, Rufus Cartwright, Natalia Price
1 Patient Selection and Assessment for Laparoscopic
13 Laparoscopic Hysteropexy: Procedure Steps and
Urogynaecology 1
Evidence 101
Graham Chapman, Robert Pollard
Yara Abdelkhalek, Nikolaus Veit-Rubin, Bruno Deval
2 Patient Counselling and the Consent Process for
14 Laparoscopic Sacrocolpopexy: Procedure Steps
Laparoscopic Urogynaecology 11
and Evidence 108
Swati Jha
Christopher Maher, Zhuoran Chen
3 Measuring Outcomes in Urogynaecologic
15 Laparoscopic Native Tissue Repair: Procedure Steps
Surgery 16
and Evidence 114
Philip M Toozs-Hobson, Dudley Robinson, Ilias Liapis
Guenter K Noé
4 Surgical Set-up, Ergonomics, Entry Techniques, Port
16 Laparoscopic Pectopexy: Procedure Steps and
Placement and Instrumentation for Laparoscopic
Evidence 120
Urogynaecology 24
Igor But, Tamara Serdinšek
Gemma Nightingale, Christian Phillips
17 Laparoscopic Colposuspension: Procedure Steps
5 Surgical Dissection and Mesh Attachment Techniques
and Evidence 129
for Laparoscopic Sacrocolpopexy 31
Matthew Izett-Kay, Alfred Cutner, Arvind Vashisht
Olivia H Chang, Katie Propst, Tonya N Thomas
18 Laparoscopic Paravaginal Repair: Procedure Steps
6 Surgical Anatomy for Laparoscopic
and Evidence 142
Urogynaecology 39
Bobby Garcia, John R Miklos, Robert D Moore
Eric S Chang, Kristie A Greene
19 Choice of Sacrocolpopexy Route Including Vaginal
7 Learning Curve in Laparoscopic Urogynaecologic
Mesh Attachment 148
Surgery: Strategies to Optimize Training and
Emily Davidson, Karl Jallad
Acquire Competence 50
Claire M McCarthy, Barry O’Reilly, Orfhlaith O’Sullivan 20 Total Laparoscopic Hysterectomy: Procedure Steps
and Evidence 155
8 Prevention and Management of Complications in
Lisa C Hickman, Katie Propst
Laparoscopic Urogynaecologic Surgery 59
Martino Zacchè, Rohna Kearney 21 Vaginal Hysterectomy and Ligamentopexy for Apical
Prolapse: Procedure Steps and Evidence 162
9 Mesh: Types and Indications for Use for Laparoscopic
Yara Abdelkhalek, Nikolaus Veit-Rubin, Bruno Deval
Urogynaecology 70
Amy Park, Graham Chapman, Marie Fidela Paraiso 22 Laparoscopic Ventral Rectopexy for Rectal Prolapse:
Steps and Evidence 170
10 Medicolegal Issues in Laparoscopic
Yara Abdelkhalek, Ohad Gluck, Bruno Deval
Urogynaecology 78
Swati Jha
Section 3: Opinion and Debate
Section 2: Procedureal Steps and Evidence
23 Hysterectomy versus Uterine Preservation in the
11 Total and Supracervical Laparoscopic Hysterectomy at
Management of Uterine Prolapse 175
Sacrocolpopexy: Procedure Steps and Evidence 85
Vladimír Kališ, Zdeněk Rušavý, Khaled M Ismail
Tsung Mou, Kimberly Kenton
v
Contents
24 Laparoscopic Hysterectomy: Total or Subtotal Section 4: Robotic Surgery
Debate 187
Kim WM van Delft, Steven ES Koops 28 The Rise of Robotic Surgery in Benign
Gynaecology 221
25 Evidence-based Approach to Concomitant
Viviana Casas-Puig, Lisa Hickman
Incontinence Surgery at the Time of
Sacrocolpopexy 194 29 Unique Advantages of Robotics in
Mugdha Kulkarni, James Alexander, Anna Rosamilia Urogynaecology 232
Siri Drangsholt, Patrick Culligan
26 Management of the Posterior Compartment in
Laparoscopic Urogynaecology: Role of Rectopexy, 30 Troubleshooting for Robotic Laparoscopic
Vaginal Rectocele Repair, and Perineorrhaphy 202 Urogynaecological Surgery: Tips and Tricks 236
Angela S Yuan, Sarah A Vogler Matt Hewitt
27 The Role of Meshes in the Treatment of Female Pelvic
Organ Prolapse 215
Yara Abdelkhalek, Christian Phillips, Bruno Deval Index 246
In addition to the content found in this textbook, additional online resources are available to complement the book.
Videos that demonstrate lectures, surgical procedures, anatomical highlights and tips and tricks can be found by using the link
below:
www.cambridge.org/phillips-resources
vi
Contributors
Yara Abdelkhalek Siri Drangsholt, MD
Obstetrics and Gynecology Department, Hôtel-Dieu de Weill Cornell Department of Urology Center for Female Pelvic
France University Hospital, St Joseph University, Beirut, Health, New York, USA
Lebanon
Kim WM van Delft, MD, PhD
Igor But Jeroen Bosch Hospital, Department of Obstetrics
Department of General Gynaecology and Urogynaecology, and Gynaecology, Henri Dunantstraat 1, 5223 GZ
Clinic for Gynaecology and Perinatology, University Medical ‘s-Hertogenbosch
Centre Maribor, Slovenia
Bruno Deval
Rufus Cartwright Department of Functional Pelvic Surgery & Oncology, Geoffroy
Department of Urogynaecology, LNWH NHS Trust, London, Saint-Hilaire, Ramsay, Générale de Santé, Paris, France
UK, and Department of Epidemiology & Biostatistics, Imperial
Bobby Garcia
College London, London, UK
Assistant Program Director, OB/GYN Residency Female Pelvic
Viviana Casas-Puig Medicine & Reconstructive Surgeon, New York City Health &
Center for Urogynecology and Reconstructive Pelvic Surgery, Hospitals – Lincoln, USA
Department of Obstetrics, Gynecology & Women’s Health
Ohad Gluck
Institute, Cleveland Clinic, Cleveland, Ohio
Department of Obstetrics and Gynecology, Edith Wolfson
Eric S. Chang, MD, MEng, FACOG Medical Center, Holon, Israel, affiliated with Sackler Faculty of
Urogynecology & Pelvic Reconstructive Surgery, Women’s Medicine, Tel Aviv University, Tel Aviv, Israel
Health & Surgery Center of Advantia, Stafford, VA, USA
Kristie A Greene, MD, FACOG
Olivia H. Chang, MD, MPH
Florida Female Urology 1900 S. Tuttle Ave Sarasota FL 34239
Assistant Professor, Division of Urogynecology and Pelvic
Reconstructive Surgery, Department of Obstetrics and Matt Hewitt
Gynecology, University of Washington
Consultant Gynaecological Oncologist, Cork University
Graham Chapman Maternity Hospital, Cork, Ireland, and Bon Secours Hospital,
Cork, Ireland. Conflict of Interest: Intuitive Surgical Proctor
Associate Professor,OB/Gyn and Women’s Health Institute
Section of Urogynecology and Pelvic Floor Disorders Lisa C. Hickman, MD
Zhuoran Chen Division of Female Pelvic Medicine and Reconstructive
Surgery, The Ohio State University Wexner Medical Center,
Royal Brisbane and Wesley Urogynaecology, Brisbane, Australia
Columbus, Ohio
Patrick Culligan, MD,
Khaled M Ismail
Weill Cornell Department of Urology Center for Female Pelvic
Department of Obstetrics and Gynecology, Faculty of
Health, New York, USA
Medicine, Charles University, Pilsen, Czech Republic, and
Alfred Cutner, MD, FRCOG Biomedical Center, Faculty of Medicine in Pilsen, Charles
Consultant Gynaecologist, University College London University, Czech Republic
Hospitals
Matthew Izett-Kay, BM, BS, MD, MRCOG
Emily Davidson, MD, FACOG Department of Urogynaecology, John Radcliffe Hospital,
Assistant Professor, Department of Obstetrics and Gynecology, Oxford University Hospitals NHS Trust, Oxford, UK, and
Urogynecology, WISH (Women’s Incontinence and Sexual Nuffield Department of Women’s & Reproductive Health,
Health) Clinic, Medical College of Wisconsin University of Oxford, Oxford, UK
vii
List of Contributors
Karl Jallad Christian Phillips
Acting Chair Obstetrics and Gynecology, Urogynecology LAU Department of Urogynaecology and Pelvic Floor Reconstructive
Medical Center, Gilbert and Rose-Marie Chagoury School of Surgery, Hampshire Hospitals, Basingstoke, Hampshire, UK
Medicine, Lebanon
Robert Pollard
Swati Jha
Associate Professor Case School of Medicine MetroHealth
Sheffield Teaching Hospitals NHS Foundation Trust Medical Center
Vladimír Kališ Natalia Price
Department of Obstetrics and Gynecology, Faculty of Department of Urogynaecology WAH NHS Trust, Worcester, UK
Medicine, Charles University, Pilsen, Czech Republic;
Katie Propst, MD
Biomedical Center, Faculty of Medicine in Pilsen, Charles
University, Czech Republic; and Department of Obstetrics and Assistant Professor of Surgery, Cleveland Clinic Learner
Gynecology, University Hospital, Pilsen, Czech Republic College of Medicine, Cleveland Clinic, Cleveland, Ohio
Rohna Mary Kearney, MD, FRCOG Dudley Robinson
Warrell Unit, Saint Mary’s Hospital, Manchester University King’s College Hospital NHS Foundation Trust
Hospitals NHS Trust, Manchester Academic Health
Anna Rosamilia
Sciences Centre, Oxford Road Manchester, and Division
Associate Professor in Urogynaecology, Head of Pelvic floor
of Developmental Biology & Medicine, School of Medical
unit, Monash Health, Melbourne, Australia
Sciences, University of Manchester
Kimberly Kenton, MD Zdenek Rusavy
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Faculty of
Department of Obstetrics and Gynecology, Northwestern Medicine, Charles University, Pilsen, Czech Republic;
University Feinberg School of Medicine, Chicago, IL Biomedical Center, Faculty of Medicine in Pilsen, Charles
University, Czech Republic; and Department of Obstetrics and
Ilias Liapis
Gynecology, University Hospital, Pilsen, Czech Republic
Birmingham Women’s and Children’s NHS Foundation Trust
Tamara Serdinšek
Christopher Maher
Department of General Gynaecology and Urogynaecology,
Royal Brisbane and Wesley Urogynaecology, Brisbane, Australia Clinic for Gynaecology and Perinatology, University Medical
John R Miklos Centre Maribor, Slovenia
Director of Urogynecology, Atlanta Urogynecology Steven E Schraffordt Koops, MD, PhD
Associates, Adjunct Professor Obstetrics/Gynecology, Emory Meander Medical Center, Department of Urogynecology,
University Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
Robert D Moore Tonya N. Thomas, MD
Director Advanced Pelvic Surgery Miklos & Moore Center for Urogynecology and Pelvic Reconstructive Surgery,
Urogynecology and Cosmetic Vaginal Surgery Professor (Adj) Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH,
OB/GYN Emory University School of Medicine Atlanta, GA USA 44195, USA
Tsung Mou, MD Philip Toozs-Hobson
Division of Female Pelvic Medicine and Reconstructive Surgery, Birmingham Women’s and Children’s NHS Foundation Trust
Department of Obstetrics and Gynecology, Northwestern
Arvind Vashisht, MA, MD, FRCOG
University Feinberg School of Medicine, Chicago, IL
Consultant Gynaecologist, University College London
Gemma Nightingale Hospitals
Consultant Gynaecologist, Boulcott Hospital, Wellington, New
Nikolaus Veit-Rubin
Zealand
Department of Obstetrics and Gynecology, Medical University
Guenter K. Noé, MD, PhD of Vienna, Vienna, Austria
President ISGE (Int. Soc. Gyn Endoscopy), Head of Department
Sarah A Vogler, MD, MBA
Obstetrics/Gynecology Rheinlandclinics Dormagen, and
Department of Colorectal Surgery, Digestive Disease &
Assisstant Professor, University of Witten Herdecke
Surgery Institute, Cleveland Clinic, Cleveland, Ohio
Marie Fidela R. Paraiso, MD, FACOG, FPMRS
Angela S Yuan, MD, FACOG
Professor of Obstetrics, Gynecology, and Reproductive
Urogynecologist, Trinity Health of New England, Hartford,
Biology, Cleveland Clinic Lerner College of Medicine of
CT, USA
Case Western Reserve University, and Vice Chair, OBGYN
and Women’s Health Institute, Cleveland Clinic Board of Martino Maria Zacchè, MRCOG
viii Governors, Cleveland, Ohio Birmingham Women’s Hospital, Birmingham, UK
Basic Principles in Laparoscopic Urogynaecology
Section 1
Chapter Patient Selection and Assessment for Laparoscopic
1 Urogynaecology
Graham Chapman, Robert Pollard
Introduction are particularly impacted, placing those with significant cardio-
pulmonary disease at higher risk.
The laparoscopic approach to surgery has revolutionized mod-
ern healthcare. With advances in training and accessibility, the Cardiac Changes
worldwide impact of this minimally invasive surgical modality
Cardiovascular function changes during laparoscopic surgery
continues to grow exponentially. High quality data continue
in response to a combination of mechanical and endocrine
to show advantages of laparoscopic surgery compared to open
changes. Upon peritoneal entry and insufflation, a vaso-vagal
surgery in a variety of surgical fields, including lower rates of
response resulting in severe bradycardia can rarely occur, requir-
comorbidity, lower healthcare costs related to length of hos-
ing immediate release of pneumoperitoneum [4]. Typically,
pitalization, and expedited patient recovery [1,2,3]. In urogy-
as pneumoperitoneum is established, mechanical pressure
naecology, laparoscopy can be utilized in the surgical repair of
on the vasculature results in alterations in venous return, sys-
pelvic floor disorders, representing a versatile modality that
temic vascular resistance, blood pressure, and cardiac output.
can address the range from simple to the most complex cases.
Catcholamine release is increased. Carbon dioxide is absorbed
Adaptation of this modality greatly expands the repertoire of
trans-peritoneally, resulting in hypercarbia which produces
the urogynaecologic surgeon, and simultaneously can expand
acidosis, altered myocardial contractility, and sensitivity to
patient access to quality surgical care. The preoperative, intraop-
arrhythmia [5]. Many of these effects are further exacerbated
erative, and postoperative care in laparoscopy differs from that
by the Trendelenburg position. In the healthy individual, these
of vaginal or open surgery. This chapter will review the nuances
cardiovascular changes are readily compensated for, even in
of patient assessment and selection in urogynaecologic surgery.
prolonged surgeries. Though, caution must be exercised when
General Approach to Laparoscopic Surgery considering laparoscopic surgery for patients who have signifi-
cant cardiac risk factors, including those with severe conges-
Laparoscopic surgery is used to perform abdominal surgery tive heart failure, cardiac valvular disease, and coronary artery
in a minimally invasive fashion. Limitations in laparoscopic disease.
surgery are few, particularly in the field of urogynaecology,
where surgery is largely elective and non-emergent. Dependent Pulmonary Changes
on the skill and comfort level of the surgeon, any abdominal Pulmonary changes during laparoscopy also occur in response
urogynaecologic procedure can be performed laparoscopically. to the effects of pneumoperitoneum and patient position-
Although, there are a number of factors that must be consid- ing. The head-down positioning in Trendelenburg as well as
ered in the patient evaluation prior to performing laparoscopic increased intra-abdominal pressure from insufflation results
surgery. This evaluation should be primarily centred around in cephalad displacement of the diaphragm, causing decreased
patient safety. Potential risks unique to laparoscopic surgery can functional residual capacity, vital capacity, and lung compli-
be medical or surgical. Thus, the patient assessment must con- ance [4]. Extended periods in a steep Trendelenburg position
sider both medical comorbidities that increase risk related to the can induce swelling that, when severe, can be obstructive to the
physiologic stressors in laparoscopic surgery, as well as surgical airway, requiring prolonged intubation. Additionally the hyper-
factors that may increase risk of injury. capnic state induced by carbon dioxide absorption requires
an increase in minute ventilation. While these changes can be
Physiologic Changes in Laparoscopic Surgery
compensated for with ventilation settings in the healthy patient,
A number of physiologic changes occur that are inherent to those with severe pulmonary disease may not be able to tolerate
laparoscopic surgery. Consideration of how preexisting medi- a more extensive laparoscopic surgery. Thus patients with severe
cal comorbidities may impact the risk of these changes should asthma, chronic obstructive pulmonary disease, emphysema,
be performed in conjunction with the anaesthesiology provid- pulmonary fibrosis, pulmonary hypertension, and severe obe-
ers. The majority of intraoperative physiologic changes unique sity should be optimized and carefully considered for laparo-
to laparoscopy are related to the synergistic effects of increased scopic surgery. Given that open surgery presents another set of
intra-abdominal pressure, carbon dioxide absorption, and the considerable risks in these patients, the implications of needing
Trendelenburg position. While these factors affect patients in to convert to laparotomy due to an intolerance to the effects of
a variety of ways, the cardiac, vascular, and pulmonary systems laparoscopy should be emphasized in these patients.
1
