Laparoscopic sacrocolpopexy using Seratex Slimsling: pilot study.

OBJECTIVE: To describe a new technique of laparoscopic sacrocolpopexy using material Seratex Slimsling. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, Vyškov Hospital; Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc. METHODS: Using a laparoscopically inserted Seratex Slimsling material, we performed a sacrocolpopexy in 12 patients with pelvic prolapse between November 2018 and June 2019. All patients were operated at the same workplace by the same surgeon with experience in advanced laparoscopic surgery. We monitored age, parity, BMI, previous hysterectomy, surgical time, blood loss, type of concomitant surgery, length of hospitalization and incidence of peroperative and postoperative complications in the pilot group of patients Results: Patients included in the pilot study were 53.2 ± 10.0 (34-74) years old, BMI 24.7 ± 4.2, parity 1.92 (95.7% of whom were vaginal births) and in 5 cases (41.7%) previous hysterectomy was performed. The mean duration of surgery was 58.4 ± 6.6 min in cases without hysterectomy and 102 ± 4.9 in patients with concomitant hysterectomy. The mean blood loss was 93 ± 78.8 ml and the length of hospitalization was 5.25 ± 0.72 days. There was no injury to large vessels or ureters during any operation and none of the operations was converted to laparotomy. In one case, the implant slipped from the sacrouterine ligaments area and subsequently the vaginal stump prolapse recurred three months after the primary operation. The patient was re-operated six months after the primary operation using the same technique and has been without any problems until now. In the monitored postoperative period, we did not notice any protrusion of the implant or significant dyspareunias or discomfort in any of the patients. Apart from one patient mentioned above, the method did not fail. CONCLUSION: Laparoscopy has had an irreplaceable role in gynecological surgery for pelvic prolapse since 1993. It is possible to perform laparoscopic sacrocolpopexy with high success rate nad minimal incidence of complications with the use of Seratex Slimsling.

Consecutive intrapartum uterine rupture following endoscopic resection of deep rectovaginal and bladder endometriosis.

OBJECTIVE: To present case report of patient with repeted endoscopic resections of deep infiltrating endometriosis (DIE) to demonstrate its possible risks for subsequent delivery. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, Central Moravian Hospital Trust, Member of Agel holding, Prostějov, Czech Republic; Department of Obstetrics and Gynecology, Vyškov Hospital, Czech Republic; Department of Pathology, Vyškov Hospital, Czech Republic; Department of Pathology, University Hospital Brno, Medical faculty, Masaryk University Brno, Czech Republic; Department of Obstetrics and Gynecology, Palacky University, Faculty of Medicine and Dentistry, Olomouc, Czech Republic. METHODS AND RESULTS: We are presenting a case of 29 years old patient with multiple laparoscopic surgery for deep infiltrating endometriosis (DIE). At the same time, new risks are posed to the delivery process like a severe injuries of the uterine attachment aparate, vagina, parametria with the risk of developing life threatening bleeding. These case we presented here demonstrates the emergence of new risks and complications for another pregnancy with such women. CONCLUSION: Our case report demonstrates new possible obstetric risk factors as consequence of increasing radicality in surgical treatment of DIE.