Laparoscopic Pelvic Floor Surgery

Laparoscopy offers better exposure and surgical detail, avoids the need for excessive abdominal packing and bowel manipulation, next to reduced blood loss and lesser morbidity. It is therefore the ideal approach for pelvic floor procedures to treat urinary incontinence, pelvic organ, and rectal prolapse. The most commonly performed procedures are sacrocolpopexy, rectopexy, and colposuspension, which evolved from the stage of technical experimentation (1990s) and uncontrolled studies (early twenty-first century) to procedures for which today level I evidence is available that they provide equally good outcomes as their open counterparts. Offering a combination of incontinence, vaginal prolapse, and rectal surgery requires a multidisciplinary surgical team. The generic limitations of laparoscopy are its steep learning curve and long operation times, the limited number of degrees of freedom and its two-dimensional vision. Those limitations may in part or completely be overcome by a robotic approach, though there are no studies demonstrating a clinical benefit. Robotic surgery may shorten the learning curve for surgeons not familiar with “straight stick” laparoscopy, but remains expensive. This may change in the near future as more competitors will be on the market. Likewise, colposuspension may rekindle because of the negative advertisement for synthetic materials making patients ask for alternatives for mid-urethral slings.