Urbankova Iva, Callewaert Geertje, Sindhwani Nikhil, Turri Alice, Hympanova Lucie, Feola Andrew, Deprest Jan
Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Prague;
Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Pelvic Floor Unit, University Hospitals KU Leuven.
J Vis Exp. 2017 Jul 27(125):55706. doi: 10.3791/55706.
This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.
本方案描述了在绵羊中使用单阴道切口技术将网片插入直肠阴道隔的方法，包括有和没有套管针引导下锚定臂的插入。经产绵羊接受直肠阴道隔的解剖，然后插入带有或不带有四个锚定臂的植入物，两者均设计为适合绵羊解剖结构。使用套管针和“由外向内”技术放置锚定臂。头侧臂穿过闭孔肌、股薄肌和大收肌。尾侧臂通过尾骨肌固定在骶结节韧带附近。该技术可模拟在患有盆腔器官脱垂的女性中进行的手术操作。解剖间隙和结构易于识别。该手术最关键的部分是头侧套管针的插入，其很容易穿透腹腔或周围盆腔器官。这可以通过更广泛的腹膜后解剖和将套管针更向外侧引导来避免。这种方法仅设计用于在大型动物模型中对新型植入物进行实验测试，因为目前临床上不使用套管针引导插入。
