Oliver Janine L, Kim Ja-Hong
Division of Urology, University of Colorado Denver, Academic Office One Bldg, 12631 East 17th Ave, Box C319, Aurora, CO, 80045, USA.
Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California-Los Angeles Medical Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Curr Urol Rep. 2017 Sep;18(9):66. doi: 10.1007/s11934-017-0715-6.
Pelvic organ prolapse (POP) is a highly prevalent condition among women that, although non-life threatening, can significantly impact daily activities and quality of life (QOL). Sacrocolpopexy (SC) has been touted by many as the "gold standard," citing superior anatomic success rates compared to transvaginal approaches for apical prolapse repair. In line with current trends throughout the surgical field, robotic-assisted laparoscopic sacrocolpopexy (RSC) has rapidly gained popularity. This review will present the most contemporary evidence examining RSC and discuss whether it has met criteria to qualify as the "treatment of choice" for advanced apical vaginal prolapse.
Recent findings support the superior durability of SC for apical prolapse repair compared to native tissue vaginal approaches. Recent evidence demonstrates that anatomic outcomes of minimally invasive sacrocolpopexy, including RSC, are no different than those of traditional ASC. Low quality evidence suggests lower rates of dyspareunia with SC compared to vaginal repairs. RSC may be cost-effective when compared to ASC. When compared to LSC, however, RSC is more expensive and associated with longer operating times. RSC is an excellent option for many women who desire the most durable option for definitive repair of advanced apical POP.
盆腔器官脱垂(POP)在女性中非常普遍,虽然不危及生命,但会显著影响日常活动和生活质量(QOL)。许多人将骶棘韧带固定术(SC)吹捧为“金标准”,理由是与经阴道修复顶端脱垂的方法相比,其解剖学成功率更高。与整个外科领域的当前趋势一致,机器人辅助腹腔镜骶棘韧带固定术(RSC)迅速受到欢迎。本综述将展示研究RSC的最新证据,并讨论它是否符合作为晚期顶端阴道脱垂“首选治疗方法”的标准。
最近的研究结果支持,与自体组织阴道修复方法相比,SC修复顶端脱垂具有更高的持久性。最近的证据表明,包括RSC在内的微创骶棘韧带固定术的解剖学结果与传统的开放骶棘韧带固定术(ASC)并无差异。低质量证据表明,与阴道修复相比,SC术后性交困难的发生率较低。与ASC相比,RSC可能具有成本效益。然而,与腹腔镜骶棘韧带固定术(LSC)相比,RSC更昂贵,且手术时间更长。对于许多希望采用最持久方法来彻底修复晚期顶端POP的女性来说,RSC是一个绝佳选择。