Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
NY Pelvic Pain and Minimally Invasive Gynecologic Surgery, New York, New York.
J Minim Invasive Gynecol. 2018 May-Jun;25(4):670-678. doi: 10.1016/j.jmig.2017.10.036. Epub 2017 Nov 8.
To assess the feasibility and safety of a McCall culdoplasty at the time of total laparoscopic hysterectomy and to evaluate the differences in the total vaginal length, vaginal apex during Valsalva, and sexual function 12 months after McCall culdoplasty compared with standard cuff closure.
A pilot randomized controlled, single-masked trial (Canadian Task Force classification I).
An academic tertiary care hospital.
Women undergoing total laparoscopic hysterectomy for benign indications from June 2013 to December 2013.
Women were randomized (1:1) to McCall culdoplasty followed by standard cuff closure versus standard cuff closure. Patients underwent Pelvic Organ Prolapse Quantification examination and completed the Female Sexual Function Index immediately before surgery and at 6 months and 12 months postoperatively. The primary outcome was the operative time. Secondary outcomes included estimated blood loss, complications, total vaginal length, vaginal apex during Valsalva, and sexual function.
This study included 50 patients. The groups were similar in terms of preoperative and surgical characteristics. The operative time did not differ between the groups. The estimated blood loss and complications were also similar. The loss to follow-up was similar in both groups. Changes in the total vaginal length, vaginal apex during Valsalva, sexual function, and pain with intercourse did not differ between the groups.
In this pilot study, the addition of McCall culdoplasty to standard cuff closure during total laparoscopic hysterectomy was not associated with an increase in operative time, estimated blood loss, or surgical complications. No differences in the total vaginal length or vaginal apex during Valsalva were observed at the 12-month follow-up. There were no differences in sexual dysfunction or dyspareunia. Given the well-established risk reduction for the development of apical prolapse with McCall culdoplasty during vaginal hysterectomy, this procedure may be a feasible and safe addition to total laparoscopic hysterectomy.
评估在全腹腔镜子宫切除术中行麦卡 culdoplasty 的可行性和安全性，并评估与标准袖口关闭相比，麦卡 culdoplasty 后 12 个月总阴道长度、Valsalva 期间阴道顶点和性功能的差异。
一项试点随机对照、单盲试验（加拿大任务组分类 I）。
学术三级保健医院。
2013 年 6 月至 2013 年 12 月因良性指征接受全腹腔镜子宫切除术的女性。
患者随机（1:1）分为麦卡 culdoplasty 后行标准袖口关闭组与标准袖口关闭组。患者接受盆腔器官脱垂量化检查，并在术前、术后 6 个月和 12 个月完成女性性功能指数。主要结局是手术时间。次要结局包括估计失血量、并发症、总阴道长度、Valsalva 期间阴道顶点和性功能。
本研究共纳入 50 例患者。两组患者在术前和手术特征方面相似。两组手术时间无差异。估计失血量和并发症也相似。两组失访率相似。总阴道长度、Valsalva 期间阴道顶点、性功能和性交疼痛的变化在两组之间无差异。
在这项试点研究中，在全腹腔镜子宫切除术中行麦卡 culdoplasty 加标准袖口关闭与手术时间、估计失血量或手术并发症的增加无关。在 12 个月的随访中，总阴道长度或 Valsalva 期间阴道顶点没有差异。性功能障碍或性交痛也没有差异。鉴于麦卡 culdoplasty 在阴道子宫切除术中对顶端脱垂的发展具有明确的风险降低作用，因此该手术可能是全腹腔镜子宫切除术的一种可行且安全的附加手术。
