Suprapubic transvesical laparoendoscopic single-site surgery for vesicovaginal fistula repair: a case report
Suprapubic transvesical laparoendoscopic single-site surgery for vesicovaginal fistula repair: a case report
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DOI：
10.5114/wiitm.2011.30816
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发表时间：
2012-01-01
影响因子：
1.7
通讯作者：
Krajka, Kazimierz
中科院分区：
文献类型：
--
作者：
Roslan, Marek;Markuszewski, Marcin M.;Krajka, Kazimierz
一些微创技术已被引入，以减少与标准腹腔镜手术相关的发病率。其中一种方法是腹腔镜单部位手术（LESS），也可用于经膀胱手术。本研究的目的是介绍我们使用该技术进行经膀胱膀胱阴道瘘（VVF）修复的初步临床经验。2011年8月，我们对一名72岁女性进行了直径3 mm的膀胱阴道瘘的LESS修复，保守治疗失败的病人该手术采用单孔器械（4通道，TriPort+，Olympus Winter&IBE GMBH）经耻骨联合上方2 cm处的1.5 cm切口经膀胱（经皮腔内入路）进行。使用标准10 mm光学和直型腹腔镜器械。切开瘘管并部分切除。用连续可吸收V-Loc（Covidien，Norwalk，CT，USA）缝线将膀胱和阴道壁缺损分两层闭合。输尿管导管留置5天，Foley导管留置14天。手术时间为170 min，失血量极少。未观察到并发症。术后期间平安无事。在6个月的随访中，患者报告没有尿液不自主地排入阴道。诊断扫描显示没有VVF的存在，实验室检查结果均在正常范围内。虽然需要大量的工具和技能的发展，经膀胱的LESS膀胱阴道瘘修复术似乎是可行和安全的。然而，还需要进一步的经验和观察。
Some minimally invasive techniques have been introduced to decrease morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery (LESS), which can also be applied for transvesical surgery The aim of the study was to present our initial clinical experience of using this technique for transvesical vesicovaginal fistula (VVF) repair In August 2011, we carried out the LESS repair of a 3-mm in diameter vesicovaginal fistula on a 72-year-old woman, who failed the conservative treatment with Foley placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (4-channel, TriPort+, Olympus Winter&IBE GMBH) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and partially excised. The bladder and vaginal wall defects were closed in two layers with running absorbable V-Loc (Covidien, Norwalk, CT, USA) suture. Ureteral catheters were left for 5 days and the Foley catheter for 14 days. The operative time was 170 min. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 6-month follow-up the patient reported no involuntary discharge of urine into the vagina. Diagnostic scans revealed no presence of VVF and laboratory examination results were all within the normal range. Although substantial development of the instruments and skills is needed, the transvesical LESS vesicovaginal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.