Meta-Analysis of Laparoscopic Versus Vaginal Uterosacral Ligament Suspension

Objective

: We set out to systematically evaluate and compare the safety and efficacy outcomes of laparoscopic and vaginal approaches in uterosacral suspension.

Data Sources

: We searched major databases using appropriate terms to find studies comparing laparoscopic (or robotic-assisted laparoscopic) versus vaginal techniques for the repair of pelvic organ prolapse (POP). We searched from each database’s inception until January 01, 2024.

Methods of Study Selection

: We included studies of patients undergoing POP surgery via either vaginal or laparoscopic routes, with or without concomitant hysterectomy. Ultimately, 9 studies met our criteria.

Tabulation, Integration, and Results

: We conducted this meta-analysis utilizing Review Manager Software and OpenMeta [Analyst]. The laparoscopic group had a longer operative time (mean difference [MD] = 5.77 minutes, p = .02, I² = 47%) and lower estimated blood loss (MD = –49.71 mL, p = .05, I² = 81%). The length of hospital stay was similar between groups (MD = –0.26 days, p = .28, I² = 97%). The recurrence rate of any POP was lower in the laparoscopic group (risk ratio [RR] = 0.53, p = .03, I² = 0%). There were no significant differences in anatomical success rate (RR = 1.06, p = .16, I² = 35%), dyspareunia (RR = 0.79 p = .5, I² = 0%), or postoperative POP quantification stages I (RR = 1.11, p = .31, I² = 60%), II (RR = 0.93, p = .77, I² = 0%), and III (RR = 0.54, p = .52, I² = 0%). Following subgroup analysis with only cases that did not include hysterectomy, the differences in operative time ([–3.26,9.77] [p = .11]; I² = 55%), and estimated blood loss ([–55.75,7.66]) [p =.14]; I² = 54%) were no longer statistically significant.

Conclusion

Both techniques proved effective. Laparoscopic uterosacral ligament suspension (L-USLS) involved longer operative times and less blood loss than vaginal-USLS. Adjusting for concomitant hysterectomy eliminated differences in operative time, blood loss, and hospital stay. Both methods showed similar hospital stay lengths, urinary tract infection rates, transfusion needs, reoperation rates, readmission rates, dyspareunia, and postoperative POP quantification stages. L-USLS displayed lower POP recurrence and urinary retention rates. While L-USLS may have advantages with hysterectomy, particularly in reduced blood loss, vaginal-USLS is also viable without hysterectomy. Due to study heterogeneity and lack of large randomized controlled trial data, more rigorous studies are essential to better define these surgical options.