Saint Clare's Health System, Denville, NJ 07834, USA.
Updates Surg. 2012 Mar;64(1):53-7. doi: 10.1007/s13304-011-0107-2. Epub 2011 Sep 6.
Uterine prolapse is one of the common reasons for hysterectomy throughout the world. However, recent data has shown that uterine-sparing techniques appear to be equivocal to that of hysterectomy. Older reports of intra-abdominal uterine suspension describe open approaches and more recent descriptions involve robotic and laparoscopic approaches utilizing mesh. We describe the first reported laparoendoscopic single-site (LESS) sacral hysteropexy utilizing a strip of polypropylene mesh placed posteriorly on the uterus and attached to the sacral promontory. A 45-year-old female with grade 3 uterine prolapse, cystocele, and rectocele underwent the procedure. The procedure involved access utilizing a single-port system placed transumbilically, and dissection using articulating laparoscopic instruments. The hysteropexy was completed by placing a 3-cm wide strip of polypropylene mesh along the posterior vaginal wall and cervicouterine junction, and suturing the proximal end to the anterior longitudinal ligament overlying the sacral promontory. The patient was discharged home within 18 h of the procedure. At 6 month follow-up, the patient has excellent anatomic support, with no evidence for recurrence of prolapse. LESS hysteropexy appears to be a safe, effective procedure for uterine prolapse and provides patients with excellent outcome with no visible scar. Additional studies will determine whether the LESS approach provides any benefit when compared with robotic or traditional laparoscopic approaches with respect to blood loss, pain, and time of full recovery.
子宫脱垂是全世界子宫切除术的常见原因之一。然而，最近的数据表明，保留子宫的技术似乎与子宫切除术相当。早期关于腹内子宫悬吊术的报告描述了开放性方法，而最近的描述则涉及使用网片的机器人和腹腔镜方法。我们描述了首例经脐部单孔腹腔镜下骶骨固定术（LESS），该手术使用一片置于子宫后方的聚丙烯网片，并固定在骶骨岬上。一名 45 岁的女性患有 3 度子宫脱垂、膀胱膨出和直肠膨出，接受了该手术。该手术通过脐部单孔系统进行，使用关节式腹腔镜器械进行解剖。通过在阴道后壁和宫颈子宫连接处以 3 厘米宽的聚丙烯网片进行固定，并将近端缝合到覆盖骶骨岬的前纵韧带，完成了子宫固定术。患者在手术后 18 小时内出院。在 6 个月的随访中，患者的解剖结构得到了很好的支撑，没有脱垂复发的迹象。LESS 子宫固定术似乎是一种安全有效的子宫脱垂治疗方法，为患者提供了极好的结果，没有明显的疤痕。进一步的研究将确定与机器人或传统腹腔镜方法相比，LESS 方法在出血量、疼痛和完全恢复时间方面是否有任何优势。
