Schaub Marie, Lecointre Lise, Faller Emilie, Boisramé Thomas, Baldauf Jean-Jacques, Wattiez Arnaud, Akladios Cherif Youssef
Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
Service de Chirurgie Gynécologique, Hôpitaux Universitaires, Strasbourg, France.
J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1081-1082. doi: 10.1016/j.jmig.2017.04.003. Epub 2017 Apr 18.
To illustrate laparoscopic sacral colpopexy for pelvic organ prolapse, a new method using a simplified mesh fixation technique, with only 6 fixing points.
Step-by-step explanation of the surgery using video (educative video). The video was approved by the local institutional review board.
University Hospital of Strasbourg, France (Canadian Task Force Classification III).
Women with multicompartment prolapse.
We first dissected the promontorium and vertically incise the posterior parietal peritoneum on the right pelvic sidewall up the pouch of Douglas. We then dissect the rectovaginal septum up to the anal cap, laterally exposing the puborectalis muscle on each side. Middle rectal vessels can be coagulated and cut without increasing the risk of digestive disorders (especially constipation), but it is preferable to conserve them if the space is sufficient for suture. Then, we dissect the vesicovaginal space and realized the subtotal hysterectomy. Finally, we realized the fastening of the anterior and posterior meshes. The particularity is that we performed only 6 points for fixing the meshes: 1 on the puborectalis muscle on each side without tension (to reduce the risk of mesh contracture, dyspareunia, and chronic pelvic pain), 1 for the fixing of the anterior mesh on the anterior vaginal wall at the level of the bladder neck, and 1 on each side of the cervix for the reconstitution of the pericervical ring gathering together the anterior mesh, the pubocervical fascia, and the insertion of the uterosacral ligament at the level of the cervix and the posterior mesh. The sixth stitch fastened 1 of 2 meshes to the anterior paravertebral ligament at the level of the sacral promontory. We finished with the peritonization.
The duration of surgery lasts approximately 120 minutes in well-experienced hands. Based on our experience the 6-point technique was relatively simple (few laparoscopic stiches) with few operative difficulties and was also associated with a low rate of reintervention.
Surgical management of middle compartment prolapse could be performed quickly and efficiently under laparoscopy with the "6-points" technique.
阐述用于盆腔器官脱垂的腹腔镜骶骨阴道固定术，这是一种采用简化网片固定技术的新方法，仅需6个固定点。
使用视频（教学视频）对手术进行逐步讲解。该视频已获当地机构审查委员会批准。
法国斯特拉斯堡大学医院（加拿大工作组分类III级）。
多部位脱垂的女性。
我们首先解剖骶岬，在右盆腔侧壁垂直切开后腹膜直至Douglas陷凹。然后向上解剖直肠阴道隔直至肛柱，在两侧横向暴露耻骨直肠肌。直肠中血管可以凝固并切断而不增加消化功能障碍（尤其是便秘）的风险，但如果空间足够用于缝合，最好予以保留。接着，我们解剖膀胱阴道间隙并进行次全子宫切除术。最后，我们完成前后网片的固定。其特殊之处在于我们仅进行6个点的网片固定：两侧耻骨直肠肌上各1个无张力固定点（以降低网片挛缩、性交困难和慢性盆腔疼痛的风险），膀胱颈水平阴道前壁上1个用于固定前网片，宫颈两侧各1个用于重建宫颈周围环，将前网片、耻骨宫颈筋膜以及宫颈水平子宫骶韧带的附着处与后网片聚拢在一起。第六针将2个网片中的1个固定于骶岬水平的前椎旁韧带。最后进行腹膜化。
在经验丰富的医生操作下，手术持续时间约为120分钟。根据我们的经验，6点技术相对简单（腹腔镜缝合少），手术困难少，再次干预率也较低。
采用“6点”技术，腹腔镜下可快速有效地进行中盆腔脱垂的手术治疗。
