Journal of minimally invasive gynecology · 2018
Transvaginal Single-Port Laparoscopy Pelvic Reconstruction with Y-Shaped Mesh.
Клинический случайСтатьяПоддержка исследования: вне правительства СШАVideo-Audio MediaНазвание и аннотация: Перевод в очереди
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Chen Yisong, Li Junwei, Hua Keqin
Аннотация
STUDY OBJECTIVE: To demonstrate a new technique for pelvic reconstruction in patients with multiple-compartment pelvic organ prolapse (POP) using Y-shaped mesh via transvaginal single-port laparoscopy.
DESIGN: Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III).
SETTING: It is more and more prudent for pelvic floor reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of pelvic reconstruction via natural orifice transluminal endoscopic surgery is feasible.
INTERVENTIONS: The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm "window" of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the pelvic peritoneum was closed, a "window" of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up.
CONCLUSION: Transvaginal single-port laparoscopic pelvic reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.
DESIGN: Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III).
SETTING: It is more and more prudent for pelvic floor reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of pelvic reconstruction via natural orifice transluminal endoscopic surgery is feasible.
INTERVENTIONS: The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm "window" of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the pelvic peritoneum was closed, a "window" of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up.
CONCLUSION: Transvaginal single-port laparoscopic pelvic reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.