Original Research
The Utilization of Magnets in Laparoscopic Uterine Prolapse Repairs Alicia R. Chen, Daphne T. Simo, Megan K. Taylor, Marty Harvill, Ph.D., Mojgan Parizi-Robinson, Ph.D.
Abstract Uterine prolapse is characterized by the herniation of the uterus into or externally from the vagina, resulting from weakening ligamentous and fascia support (Dangal, 2005). Currently, the most effective treatment option for women experiencing uterine prolapse is through the laparoscopic fissure of the uterus and subsequent vaginal removal, referred to as a laparoscopic vaginal hysterectomy (Maher, 2001; Reich et al., 1989). The common issues in its practice, including potential infections at multiple port sites, coupled with limited field-of-view and depth perception, has led to the consideration of alternative and alleviated methodologies. Previous studies supporting the introduction of magnets in conjunction with other laparoscopic methods suggest possible alleviation of surgical healing time and invasiveness and therefore have prompted an investigation of using magnets to resolve issues concerning laparoscopic hysterectomies. Contrived to resemble a true uterine prolapse, the study design considerations included a laparoscopic box simulation that was constructed to combine the basic FLS tasks of cutting patterns and peg transfer (Ritter & Scott, 2007). Trials consisted of a controlled trial modeling the current standard of care with comparison to a magnetic-enhanced trial. A numerical score system was developed to account for speed and errors encountered by participants. Participants were composed of 22 undergraduate students enrolled in a beginner’s laparoscopic course. Analysis of score values via a paired t-test illustrated a significant difference (p = 0.0008) between techniques, indicating that the use of magnets caused a decrease in the overall efficiency of the procedure. This comparative analysis of traditional laparoscopy and the integration of magnets serves to provide preliminary insight on novel applications in laparoscopic procedures and additional information surrounding patient outcomes following prolapse repairs.
Introduction Female pelvic floor dysfunction can manifest itself in a multitude of conditions, with general increases in prevalence following advancement in age, menopausal status, obesity, vaginal childbirth, connective tissue disorders, and chronic straining (Milsom & Gyhagen, 2014; Smith et al., 2014). Previous studies suggest the global prevalence of pelvic organ prolapse is estimated to be around 60% and between 2-20% for all parous women and premenopausal women, respectively (Dangal, 2005; Smith et al., 2014). These dysfunctions are often encountered in the form of uterine prolapse, commonly described as the descent of the uterus toward or through the opening of the vaginal canal following a defect in the connective tissues and pelvic musculature upholding the uterus (Uterine prolapse, 2019). According to a study conducted by the Department of Urogynecology at the University of Queensland, the preferred surgical treatment for uterine prolapse is a vaginal hysterectomy (Maher et al., 2001). In most cases, a laparoscopic approach is utilized to conduct the hysterectomy procedure. The general philosophy behind the laparoscopic technique was first demonstrated by Dr. Hans Christian Jacobaeus in 1901 and later reintroduced in the late 1980s by Dr. Hans Troidl
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(Kelley, 2008). The invention of laparoscopy has arguably transformed the field of surgery, with its proven ability to improve overall postoperative complications, such as decreased recovery time and preservation of the natural state of the human body with minimally invasive incisions (Best & Cadeddu, 2010; Park et al., 2007). Each incision made in previously standard operative procedures has generally been proven to ultimately lengthen the recovery time for the patient and suggests the rise of comorbid complications later in life, in comparison to laparoscopic methods. Differing from the historical lateral hysterectomies, a laparoscopic hysterectomy is a surgical procedure involving the use of minimally invasive instruments to effectively ligate the ovarian arteries and veins to then prepare the removal of the uterus vaginally (Lange et al., 2019). This procedure is initiated with a small incision site, or port, that is made in the navel region of the abdomen where a laparoscope (a thin fiber-optic tool characterized by its high-intensity light and high-resolution camera) is inserted into the abdominal wall for internal visualization of the pelvic region for surgical viewing (Shiel Jr, 2018). Two subsequent incisions are made in the lower
