Gynecologic use of robotically assisted laparoscopy: sacrocolpopexy for the treatment of high-grade vaginal vault prolapse
Gynecologic use of robotically assisted laparoscopy: sacrocolpopexy for the treatment of high-grade vaginal vault prolapse
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DOI：
10.1016/j.amjsurg.2004.08.022
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发表时间：
2004-10-01
影响因子：
3
通讯作者：
Chow, GK
中科院分区：
文献类型：
--
作者：
Elliott, DS;Frank, I;Chow, GK
经腹骶骨阴道固定术是高度阴道穹隆脱垂患者的一种极好的治疗选择，长期成功率为93%至99%。然而，与阴道修补术相比，它与发病率增加有关。在这篇文章中，我们描述了一种新的微创技术阴道穹窿脱垂修复，并提出我们的初步经验。手术技术涉及放置4个腹腔镜端口，3个用于手术机器人，1个用于助手。然后使用不可吸收的膨体聚四氟乙烯缝线将Prolene补片连接到骶骨岬和阴道尖。在手术结束时，补片材料被腹膜覆盖。在过去的18个月里，共有20名患者在我们的机构接受了机器人辅助腹腔镜骶骨阴道固定术治疗严重症状性阴道穹窿脱垂; 20名患者中的8名（40%）接受了伴随的抗尿失禁手术。平均随访时间为5.1（范围，1 - 12）个月，平均年龄为66（范围，47 - 82）岁。平均总手术时间为3.2（范围，2.25 - 4.75）小时。在这些患者中，1例继发于不利的解剖结构而转为开放手术。除1名患者在术后第2天离开外，所有患者均在过夜后出院。并发症仅限于2例患者的轻度输液港部位感染，经口服抗生素治疗后消退。1例患者出现复发性3级直肠前突，但无膀胱膨出或肠膨出的证据。2例患者出现明显尿失禁（> 1个垫/天）。所有18名患者都对手术结果表示满意，所有10名患者都会推荐给朋友。这种用于阴道穹隆脱垂修复的新技术结合了开放性骶骨阴道固定术的优点和腹腔镜手术的降低发病率和改善美容效果。它与减少住院时间、低并发症和转换率以及高患者满意度相关。虽然我们的早期经验是令人鼓舞的，但需要长期数据来证实这些发现并确定修复的寿命。(C)2004 Excerpta Medica，Inc. All rights reserved.
Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade vaginal vault prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with vaginal repairs. In this article, we describe a novel minimally invasive technique of vaginal vault prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic vaginal vault prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1-12) months and mean age was 66 (range, 47-82) years. The mean total operative time was 3.2 (range, 2.25-4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for vaginal vault prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair. (C) 2004 Excerpta Medica, Inc. All rights reserved.