Sarlos Dimitri, Aigmueller Thomas, Magg Heimo, Schaer Gabriel
Department of Obstetrics and Gynecology, Kantonsspital Aarau, Aarau, Switzerland.
Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
Am J Obstet Gynecol. 2015 Jun;212(6):824.e1-3. doi: 10.1016/j.ajog.2014.12.005. Epub 2014 Dec 10.
Laparoscopic sacrocolpopexy is a well-established technique to treat apical vaginal prolapse. De novo micturition disorders, pelvic pain, and defecation disorders have been reported and may be due to intraoperative compromise of the superior hypogastric plexus. The video demonstrates our technique for nerve-sparing laparoscopic sacrocolpopexy. The patient is a 62-year-old woman with symptomatic stage III posthysterectomy vaginal vault prolapse. Key steps of the procedure are opening the peritoneum at the level of the promontory, identification of the fibers of the superior hypogastric plexus, deep anterior and posterior dissection with attachment of the mesh to the vagina, displacement of the nerve fibers to the left side during suturing of the mesh to the longitudinal ligament, and complete peritonealization. This technique of the identification and protection of relevant nerve structures appears to be reproducible and can be considered by surgeons who perform laparoscopic sacrocolpopexy.
腹腔镜骶骨阴道固定术是一种成熟的治疗阴道顶端脱垂的技术。已有报道称，患者会出现新发排尿障碍、盆腔疼痛和排便障碍，这可能是由于术中上腹下丛受到损伤所致。本视频展示了我们保留神经的腹腔镜骶骨阴道固定术技术。患者为一名62岁女性，有症状的Ⅲ期子宫切除术后阴道穹窿脱垂。该手术的关键步骤包括在岬部水平打开腹膜、识别上腹下丛纤维、进行前后深部解剖并将网片附着于阴道、在将网片缝合至纵韧带时将神经纤维移至左侧以及完成腹膜化。这种识别和保护相关神经结构的技术似乎具有可重复性，进行腹腔镜骶骨阴道固定术的外科医生可以考虑采用。
