Total Pelvic Floor Lifting: A New Approach for the Anatomic Repair of Pelvic Floor Hypermobility and Vaginal Laxity in Parous Women.

Recent years have seen a steady increase in the information available regarding pelvic floor changes after childbirth. Obstetric trauma, to which all structures of the urogenital sphere are subjected, can affect different anatomical areas, including the vagina, perineum, deep pelvic floor muscles, and sphincter. Main complaints of parous women with regard to their pelvic floor are vaginal laxity, a wide introitus, and increased mobility of the uterus. Unilateral pectineal suspension is a novel method for surgical correction of the sequelae of vaginal birth-giving such as uterine hypermobility and perception of loose tissue, restoring a natural anatomy when conservative therapy has failed. Since the method is not ablative and does not interfere with anatomical structures, subsequent pregnancies and deliveries remain possible. Furthermore, there is no mesh application, adding to the safety aspects of this unique approach. The surgical technique is straightforward and can be adopted by laparoscopically trained surgeons without problems. The procedure consists of five clearly defined steps, which makes it easily reproducible. Unilateral pectineal suspension restores the pelvic floor and the vagina, with a single suture lifting the sagging structures back to their original position. If needed and according to the patient's choice, a short perineum associated with a wide introitus can be corrected in the same session by perineoplasty, resulting in a total aesthetic reconstruction of the female genital anatomy.

SOX11 and Epithelial-Mesenchymal Transition in Metastatic Serous Ovarian Cancer.

BACKGROUND: Ovarian cancer is the leading cause of death from gynecological malignancies, with serous carcinoma being the most common histopathologic subtype. Epithelial-mesenchymal transition (EMT) correlates with increased metastatic potential, whereas the transcription factor SRY-box transcription factor 11 (SOX11) is overexpressed in diverse malignancies. METHODS: In the present study, we aimed to evaluate the potential role of the immunohistochemical expression of SOX11 in 30 serous ovarian carcinomas in association with E-cadherin and vimentin expression as well as with patients' clinicopathological data. RESULTS: Most of the examined cases showed concurrent expression of E-cadherin and vimentin, whereas SOX11 was expressed in a minority of the cases (26.7%). Interestingly, the positive cases more frequently had a metastatic disease at the time of diagnosis compared with the negative cases (p = 0.09), an association, however, of marginal significance. Moreover, there was a negative correlation between E-cadherin and SOX11 expression (p = 0.0077) and a positive correlation between vimentin and SOX11 expression (p = 0.0130). CONCLUSIONS: The present work, for the first time, provides preliminary evidence of a possible implication of SOX11 overexpression in the promotion of EMT in metastatic serous ovarian cancer, thereby endorsing tumor metastasis.

Retrospective analysis of apical prolapse correction by unilateral pectineal suspension: perioperative and short-term results.

INTRODUCTION AND HYPOTHESIS: We have previously published the novel method of unilateral pectineal suspension (UPS) for apical prolapse correction. UPS provides mesh-free midline uterus suspension using a single non-absorbable suture to attach the anterior cervix to the lateral part of the iliopectineal ligament. The purpose of this retrospective cohort study was to analyze the short-term efficacy, perioperative complication rate, and overall patient acceptance of the new UPS surgical concept. METHODS: Forty-seven patients with POP-Q stage 2-4 who underwent robotic UPS between January 1, 2020 and December 31, 2021 were included in the study. Patient data were taken retrospectively from the patient files. Treatment success was the primary endpoint, measured both objectively using a defined composite endpoint and subjectively according to patients' acceptance 3-6 months after surgery during a follow-up examination. Secondary outcome measures included complications and conversions, and effect of additional procedures on operative time. RESULTS: Treatment success as measured by the defined composite endpoint was 93.6% for the entire cohort. No complications or conversions occurred. Mean operation time for isolated UPS was 46.5 min (n = 33 patients). UPS can be easily combined with additional surgical procedures for repair of remaining pelvic floor defects, incontinence surgery or other indications. Additional procedures performed had a significant influence on operation time (p < 0.0005, n = 14). CONCLUSIONS: UPS shows highly favorable results when looking at an unselected cohort of patients in need of primary POP surgery with respect to established quality parameters of POP repair.

Robotic mesh-supported pectopexy for pelvic organ prolapse: expanding the options of pelvic floor repair.

Pelvic organ prolapse affects 30-50% of the female population. For definitive treatment surgery is unavoidable. Sacrocolpopexy has been the gold standard for anatomical correction of pelvic organ prolapse since the 1990s. Recently, pectopexy has been introduced as a new surgical procedure to correct apical prolapse. We have translated the laparoscopic pectopexy into a robotic procedure. The charts of the first 30 consecutive patients who underwent robotic pectopexy at the department for robotic and pelvic floor surgery were reviewed. All patients were analyzed for estimated blood loss, operation time, as well as complications. Treatment success was evaluated after 3-6 months using a composite endpoint including anatomical and subjective components. Of the 30 patients analyzed, 18 underwent hysteropectopexy (n = 18), 6 patients underwent vaginopectopexy and 6 patients underwent cervicopectopexy. Additional procedures were performed in 14 patients, and this influenced operation time and intraoperative blood loss. No intraoperative complications were noted and no conversions were necessary. Treatment success according to the primary composite endpoint was achieved in 30 (100%) patients. Furthermore, neither de novo urgency nor obstructive bowel symptoms were noted in any of the patients treated with robotic pectopexy. Similar to SCP, pectopexy is designed for prolapse repair. The robotic technique for pectopexy capitalizes on the advantages of robotic surgery as compared to conventional laparoscopy since it allows for anatomical preparation and simplification of applying sutures and mesh material, reducing operating time and minimizing surgical trauma. The technique is safe, and anatomical outcomes are excellent.