Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Robotic repair of bilateral levator ani eventration.
СтатьяКлинический случайVideo-Audio MediaНазвание и аннотация: Перевод в очереди
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Bertucci Zoccali Marco, Kavanagh Taylor, Podolsky Dina
Аннотация
BACKGROUND: This video demonstrates a robotic approach for the repair of bilateral levator ani eventration with associated perineal hernia and obstructive defecation symptoms, including pelvic floor reinforcement and concomitant ventral mesh rectopexy.
METHODS: A surgical video (available online at XXX) demonstrates the technique step by step. A 71-year-old woman with a remote history of pelvic trauma and 4 prior vaginal deliveries presented with progressive bilateral perineal bulging and obstructive defecation. Computed tomography showed a chronic right pubic/superior ramus fracture with persistent fracture lines, bowel-containing bilateral levator ani eventration (right greater than left), and a 1.5-cm left levator plate defect.
RESULTS: A robotic repair using a 4-arm configuration was performed. Key operative steps included: (i) abdominal access and pelvic exposure with identification of the ureters; (ii) dissection from the sacral promontory to the anterior reflection with preservation of the hypogastric nerves and development of the rectovaginal plane to the perineal body; (iii) bilateral levator plate dissection and identification of an approximately 1-cm left levator defect; (iv) bilateral onlay synthetic mesh reinforcement secured with sutures and fibrin glue; (v) ventral mesh rectopexy using bioresorbable mesh secured to the anterior rectum with partial-thickness absorbable sutures and to the sacral promontory with permanent sutures; (vi) intraoperative flexible sigmoidoscopy to exclude mucosal injury; and (vii) peritoneal closure with a running barbed absorbable suture, transversus abdominis plane block, and port-site closure.
CONCLUSION: Robotic pelvic floor reinforcement with concomitant ventral mesh rectopexy is a feasible approach for symptomatic levator ani eventration with perineal hernia, enabling precise pelvic dissection, restoration of levator plate integrity, and correction of associated posterior compartment dysfunction.
METHODS: A surgical video (available online at XXX) demonstrates the technique step by step. A 71-year-old woman with a remote history of pelvic trauma and 4 prior vaginal deliveries presented with progressive bilateral perineal bulging and obstructive defecation. Computed tomography showed a chronic right pubic/superior ramus fracture with persistent fracture lines, bowel-containing bilateral levator ani eventration (right greater than left), and a 1.5-cm left levator plate defect.
RESULTS: A robotic repair using a 4-arm configuration was performed. Key operative steps included: (i) abdominal access and pelvic exposure with identification of the ureters; (ii) dissection from the sacral promontory to the anterior reflection with preservation of the hypogastric nerves and development of the rectovaginal plane to the perineal body; (iii) bilateral levator plate dissection and identification of an approximately 1-cm left levator defect; (iv) bilateral onlay synthetic mesh reinforcement secured with sutures and fibrin glue; (v) ventral mesh rectopexy using bioresorbable mesh secured to the anterior rectum with partial-thickness absorbable sutures and to the sacral promontory with permanent sutures; (vi) intraoperative flexible sigmoidoscopy to exclude mucosal injury; and (vii) peritoneal closure with a running barbed absorbable suture, transversus abdominis plane block, and port-site closure.
CONCLUSION: Robotic pelvic floor reinforcement with concomitant ventral mesh rectopexy is a feasible approach for symptomatic levator ani eventration with perineal hernia, enabling precise pelvic dissection, restoration of levator plate integrity, and correction of associated posterior compartment dysfunction.