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Aims: Laparoscopic sacral colpopexy (LSC) for pelvic prolapse is a complex procedure, characterized by an anterior mesh suspension to the sacral promontory and a posterior tension-free mesh fixation., Methods: Totals of 150 age-BMI and parity matched consecutive POP patients were selected from our Diaconesses Hospital database among women who underwent a laparoscopic supracervical hysterectomy (LSH) plus sacral colpopexy (LSC) from June 2005 to March 2010. We analyzed two group of LSC populations, according to different tension-free apical fixation of the posterior mesh: Promontory (P) group and Utero-Sacral (US) group. Studied endpoints were the anatomical and functional results linked to these different tension-free posterior mesh placements., Results: Baseline characteristics were similar between the groups. No differences in terms of anatomical and functional outcomes were observed between the groups. Pelvic organ mobility at rest versus under Valsalva highlighted a significant reduction of median differential vaginal apex only in the P population (preoperative: 30 mm and 32 mm; postoperative: 8 mm and 24 mm; for P and US, respectively; P < 0.01). No differences were found in terms of intra- or post-operative complications., Conclusions: Uterosacral tension-free fixation of posterior mesh during LSC could be considered a simple procedure and guarantees a more physiological movement of the pelvic organs if compared with promontory suspension., (© 2016 Wiley Periodicals, Inc.)

Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.

The authors present a retrospective study of 1,000 total abdominal hysterectomies performed between 1969 and 1975, and they report the main complications. Early complications are dominated by: rare thrombo-embolic accidents (2.2%) since the advent of prophylactic heparin therapy; infectious complications, dominated by the abscess of the abdominal wall and asymptomatic urinary infections, and for which simple measures prevent resorting to prophylactic antibiotherapy. The role of the hysterectomy seems minimal in the occurrence of a prolapse or a stress-related urinary incontinence: prolapses after hysterectomy (1.4%) seem more related to tissue aging than to the procedure which modifies very little the supporting system of the pelvis. A post-operative urinary incontinence is, most of the time, the result of an incomplete pre-operative work-up: failure to recognize a potential stress-related incontinence, or an incontinence secondary to an unstable bladder. Prolapse and incontinence must always be treated independently. In the psychological and sexual repercussion, age, ovariectomy and the distress related to the procedure, involving the heart of womanhood, seem to be the most important factors.