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Sacrocolpopexy With Concomitant Total vs Supracervical Hysterectomy

Functional Support Comparisons in Cadavers

Maldonado, Pedro Antonio, MD; Norris, Kyle P., MD; Florian-Rodriguez, Maria E., MD; Shah, Nemi M., MD; Wai, Clifford Y., MD

Female Pelvic Medicine & Reconstructive Surgery: May/June 2019 - Volume 25 - Issue 3 - p 213–217
doi: 10.1097/SPV.0000000000000532
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Objective This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure of functional anatomic support in human cadavers.

Methods Supracervical hysterectomy was performed on unembalmed cadaver specimens, followed by ASC attaching polypropylene mesh to the posterior cervix/vagina only and then the anterior and posterior cervix/vagina. Using a metal bolt placed through the cervix tied to a filament passing through a fixed pulley system, successive weights of 0.5 to 3.0 kg were added to provide increasing loads on the apex (cervix), and the distances traversed by the apex were recorded. The same process was then repeated in each specimen after removal of the cervix (with vaginal cuff closure). One-way and repeated-measures analysis of measure was used for between-group and within-group comparisons, respectively, with P ≤ 0.05 considered statistically significant.

Results Eight cadavers were examined. At lower weight loads, pulling distances in the 4 groups examined were similar and were not significantly different with the presence or absence of the cervix. At weight loads of 2.5 kg or greater, we noted a trend of increased pulling distances when posterior mesh only was used vs when anterior/posterior mesh was placed, although this difference was not significant. Interestingly, there was tearing of the vaginal wall or partial separation of mesh/sutures attachments to the vagina noted in 3 specimens.

Conclusions This study showed no differences in the ability of the cervix (after supracervical hysterectomy) compared with the vaginal cuff (after total hysterectomy) to resist downward traction of successive weights after ASC. Clinical trials are necessary to correlate these findings with prolapse recurrence rates and patient satisfaction following these procedures.

In this cadaver study, there was no significant differences in the ability of the cervix compared to the vaginal cuff to resist downward traction of successive weights, following sacrocolpopexy with total versus supracervical hysterectomy, respectively.

From the Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.

Correspondence: Pedro Antonio Maldonado, MD, Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 4801 Alberta Ave, El Paso, TX 79905. E-mail: pedro.maldonado@ttuhsc.edu.

The authors have declared that they have no conflicts of interest.

Financial Support: None.

Oral Presentation details: The 43rd Annual Scientific Meeting of the Society of Gynecologic Surgeons, San Antonio, TX; March 26–29, 2017.

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