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This is a prospective, randomized multicenter study whose objective is to compare two surgical techniques routinely used at our center for the correction of pelvic organ prolapse (laparoscopic cervicosacropexis versus colposuspension sec. Shull using v-NOTES).
patients with pelvic organ prolapse with a stage greater than or equal to stage 2 for the apical compartment who are candidates for surgical correction will be randomized and assigned to one of two treatment groups. The aim is to compare the anatomical, surgical and anesthesiological outcomes between these two surgical techniques, both of which are commonly used in clinical practice for the correction of this type of prolapse.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| laparoscopic cervicosacropexy (CSP) | Active Comparator |
| |
| Shull technique via V-NOTES (VNS) | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Laparoscopic cervicosacropexy | Procedure | The first step consists of a supracervical hysterectomy with morcellation. Anterior and posterior dissection of the vesicovaginal and rectovaginal space. Placing a flexible blade or a Breisky blade in the vagina which is manipulated by the assistant in order to improve exposure of the tissue planes. The retroperitoneum will then be opened from sacral promontory to cervix with the incision just medial to the uterosacral ligament. A low-weight preshaped Y-shaped polypropylene mesh will be secured to the anterior and posterior vagina with four to six separated absorbable 2.0 polyglactin sutures and two nonabsorbable 2.0 prolene sutures can be placed at the level of the remaining cervix. The mesh will be attached to the sacral promontory using two or three nonabsorbable monofilament 2.0 prolene suture. The retroperitoneal space will be closed with continuous 2.0 polyglactin suture or barbed 2.0 absorbable suture material. |
| Measure | Description | Time Frame |
|---|---|---|
| operating time | from skin/vaginal incision to end of skin/vaginal suture | intraoperative |
| post-operative pain | VAS (visual analogic scale, from 0 (minimum), to 10 (maximum pain)) | at 4 hours post-operative |
| post-operative pain | VAS (visual analogic scale, from 0 (minimum), to 10 (maximum pain)) | at 8 hours post-operative |
| post-operative pain | VAS (visual analogic scale, from 0 (minimum), to 10 (maximum pain)) | at 1 month post-operative |
| post-operative pain | VAS (visual analogic scale, from 0 (minimum), to 10 (maximum pain)) | at 12 hours post-operative |
| time to mobilization with standing | Time it takes the patient to mobilize to standing independently | immediately post-operative |
| hospital stay | hours of post-operative stay | immediately post-operative |
| patient satisfaction | assessed by P-QoL (prolapse quality of life) validated questionnaire | at 6 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| ID | Term |
|---|---|
| D056887 | Pelvic Organ Prolapse |
| ID | Term |
|---|---|
| D011391 | Prolapse |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
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We will perform a interventional, no profit, prospective, randomized 1:1 multicentre, controlled trial with participating tertiary referral hospital centers in Italy, to compare the laparoscopic cervicosacropexy (CSP) and Shull technique via V-NOTES (VNS) in the management of apical prolapse.
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The 6-week examination and review will be performed by the surgeon with all study data and future visits completed by blinded co-authors (Different surgeon or Urogynecology fellows) who will be unaware of group allocation.
|
| Shull technique via V-NOTES | Procedure | Using a cold-bladed scalpel, pericervical colpotomy and subsequent opening of the Douglas and vesico-uterine space is performed. The following step is forcipressure and section of uterosacral ligaments bilaterally with cold blade scissors and ligation in Polysorb 0. A v-PATH® wall retractor is placed, after insertion of three trocars. Total hysterectomy is then performed by standard V-NOTES technique. After transperitoneal visualization of the ureters bilaterally, the peritoneum is incised between the ureters and the uterosacral ligaments, which are thus bilaterally isolated, and three points in polydioxanone 2/0 are placed per side. The v-PATH wall retractor is then removed. Finally the suspension of the vaginal vault at the uterosacral ligaments is made according to Shull technique. Eventual fascial corrections of concomitant anterior or posterior defects will be associated if needed. |
|
| patient satisfaction | assessed by P-QoL validated questionnaire | at 3 months |
| patient satisfaction | assessed by PGI-I (patient global impression of improvement) validated questionnaires | at 6 weeks |
| patient satisfaction | assessed by PGI-I validated questionnaires | at 3 months |
| patient satisfaction | assessed by validated questionnaires (VAS, visual analogic scale from 0 to 10) | at 6 weeks |
| patient satisfaction | assessed by validated questionnaires (VAS, visual analogic scale from 0 to 10) | at 3 months |
| sexual function | assessed by FSFI (female sexual function index) questionnaire | at 6 weeks |
| sexual function | assessed by FSFI questionnaire | at 3 months |
| sexual function | assessed by TVL (total vaginal lenght) measure | at 6 weeks |
| sexual function | assessed by TVL measure | 3 months |
| recurrence of prolapse in apical compartment | POP-Q (Pelvic Organ Prolapse Quantification system) C point measure | at 6 weeks and 3 months; |
| recurrence of prolapse in apical compartment | POP-Q (Pelvic Organ Prolapse Quantification system) C point measure | at 6 weeks |
| recurrence of prolapse in the anterior and posterior compartments when present | at 3 months; |
| postoperative complications | assessed using Clavien-Dindo classification | from surgery to 3 motnhs follow.up |
| anesthesiological parameters | End tidal CO2 (carbon dioxide) assessement | intraoperative |
| anesthesiological parameters | SpO2 (oxygen saturation) assessement | intraoperative |
| anesthesiological parameters | blood pressure assessement (measured in mmHg) | intraoperative |
| anesthesiological parameters | intraoperative blood loss assessement (measured in milliliters) | intraoperative |
| anesthesiological parameters | degrees of Trendelemburg assessement | intraoperative |