Simulation of Pelvic Organ Prolapse Repair Surgery Using Computational Models of Biodegradable Implants Mimicking Uterosacral Ligaments.

Abstract

Pelvic organ prolapse (POP) is a common pelvic floor disorder resulting from weakened supportive muscles and ligaments. Although the demand for surgeries involving surgical meshes is expected to increase, current options remain limited. In 2019, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse due to safety concerns. This study aimed to develop and evaluate computational models of biodegradable implants made of polycaprolactone, designed to replicate the mechanical behavior of the uterosacral ligaments (USLs) and mitigate complications associated with traditional synthetic meshes. The goal was to assess whether such implants could effectively restore pelvic support under varying degrees of USLs damage. Sacrocolpopexy was simulated using two distinct implant geometries: three square and one sinusoidal configuration. These were integrated into a pelvic cavity computational model to evaluate performance during the Valsalva maneuver under conditions of 50% and 90% damage, as well as total rupture of the USLs. The model, established without implants, demonstrated that complete USL rupture led to an approximate 41% increase in vaginal displacement when contrasted with the healthy model. All implants demonstrated a beneficial effect, decreasing vaginal displacement. Some of these implants successfully reversed the damage-induced displacement, nearing the level of a healthy vaginal model. While further clinical and in vivo validation is essential, these findings illustrate a promising direction and contribute to the growing evidence supporting the potential of biodegradable meshes in POP surgery. However, current outcomes are derived from computational models and serve primarily as a biomechanical proof of concept.