Ramavath Krishna Kavita, Murthy Pp Srinivasa
Department of Gynecology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
J Gynecol Endosc Surg. 2011 Jan;2(1):53-7. doi: 10.4103/0974-1216.85285.
Although there are many studies the ongoing debate on the management of posthysterectomy vault prolapse whether it should be abdominal, vaginal, or laparoscopic still continues. However there is no clear consensus. Though the incidence of vaginal vault prolapse is said to range from 0.2 to 45%, the choice of the optimal treatment depends on the surgeon's experience, suitability for surgery, age, symptoms, quality of life impairment, and prolapse grade. Abdominal sacrocopopexy (ASCP) with mesh interposition is the traditional surgical procedure for treating pelvic organ prolapse and has been shown to have one of the highest long-term success rates for vaginal vault prolapse. The laparoscopic approach offers reduced morbidity, shorter hospitalization, and decreased post operative pain. The disadvantages of the laparoscopic approach include longer operating time and need for advanced laparoscopic surgical skills including suturing. Robot-assisted laparoscopic procedure allows the performance of complex laparoscopic maneuvers with less difficulty, and thereby simplifies the complex procedure. The aim is to describe and demonstrate the use and benefit of robot-assisted laparoscopic sacrocolpopexy in the treatment of posthysterectomy vaginal vault prolapse in obese patients along with mid-urethral sling application.
尽管有许多研究，但关于子宫切除术后阴道穹窿脱垂的治疗方法（无论是采用腹部手术、阴道手术还是腹腔镜手术）的争论仍在继续。然而，目前尚无明确的共识。虽然阴道穹窿脱垂的发生率据报道在0.2%至45%之间，但最佳治疗方法的选择取决于外科医生的经验、手术的适宜性、年龄、症状、生活质量受损情况以及脱垂程度。采用网片植入的腹骶骨固定术（ASCP）是治疗盆腔器官脱垂的传统手术方法，已被证明是治疗阴道穹窿脱垂长期成功率最高的方法之一。腹腔镜手术方法具有发病率降低、住院时间缩短和术后疼痛减轻的优点。腹腔镜手术方法的缺点包括手术时间较长以及需要具备包括缝合在内的先进腹腔镜手术技能。机器人辅助腹腔镜手术能够更轻松地完成复杂的腹腔镜操作，从而简化了复杂的手术过程。本文旨在描述并展示机器人辅助腹腔镜骶骨阴道固定术在肥胖患者子宫切除术后阴道穹窿脱垂治疗中的应用及益处，同时介绍中段尿道吊带术的应用。
