# Is Transvaginal Minimally Invasive Sacrospinous Ligament Fixation a Safe and Effective Surgical Approach for Treating Recurrent Apical Pelvic Organ Prolapse?

## TL;DR

This study shows that a minimally invasive surgery using the EnPlace® device is safe and effective for treating recurrent apical pelvic organ prolapse with high patient satisfaction.

## Contribution

The study introduces and evaluates the EnPlace® device for minimally invasive sacrospinous ligament fixation in recurrent apical pelvic organ prolapse.

## Key findings

- 98.8% of patients were discharged the same day with minimal complications.
- Only 13.4% of patients reported mild POP symptoms at long-term follow-up.
- Patient satisfaction averaged 90.8 with only 2.4% requiring additional intervention.

## Abstract

Background: Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace® device for treating recurrent apical POP. Methods: A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace® device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024. Results: The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP. Conclusions: Minimally invasive SSL fixation using the EnPlace® device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates.