Department of Obstetrics and Gynaecology, Epsom & St. Helier's University Hospitals NHS Trust, Epsom, United Kingdom.
Department of Obstetrics and Gynaecology, Epsom & St. Helier's University Hospitals NHS Trust, Epsom, United Kingdom.
J Minim Invasive Gynecol. 2019 Feb;26(2):356-357. doi: 10.1016/j.jmig.2018.03.025. Epub 2018 Apr 7.
To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).
Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III).
University hospital.
A 37-year-old woman with grade 3 uterine descent requested uterine-sparing surgery for symptomatic prolapse. The patient declined all mesh procedures.
Mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH).
Laparoscopic sacrohysteropexy is a uterine-preserving technique for uterine prolapse with high cure rates (92%) but with a mesh erosion risk of up to 2.5% [1,2]. Complications have resulted in reclassification of transvaginal meshes as restricted-use high-risk medical devices [3,4]. Sacrospinous hysteropexy and uterosacral ligament suspension are mesh-free alternatives, but they have increased rates of anterior-compartment failures and a 20% recurrence rate in the latter [5,6]. Laparoscopic suture sacrohysteropexy has been described with reported success rates of 95% [7]. This video demonstrates a modified-technique offering a simple, robust, and reproducible mesh-free approach to uterine-preserving prolapse surgery. We used 2 horizontal loop mattress sutures acting as a pulley to distribute the force evenly throughout the suture strand, leading to a significantly stronger and more secure hold and reducing risk of avulsion [8]. The technique starts with a careful dissection of the peritoneum from the sacral promontory to the cervix. Two permanent sutures are used, taking bites at the anterior longitudinal ligament, the uterosacral, a loop mattress in the midline at the cervix, the uterosacral on the way back, and finally at the sacral promontory. Damage to the uterine vessels is minimized by maintaining a central uterine position. The stitch is tied with caudal pressure on the uterus, applied via the uterine manipulator, approximating the cervix to the sacral promontory. The peritoneum is closed with dissolvable sutures, burying the Ethibond to prevent exposure and bowel obstruction.
Post-procedure, the uterus was well supported with a vaginal length of 15 cm.
展示一种无网片的腹腔镜子宫骶骨缝合固位术（LUSSH）。
展示用于子宫脱垂（加拿大任务组分类 III）的 LUSSH 的技术视频。
大学医院。
一名 37 岁的女性，子宫下降 3 度，因症状性脱垂要求保留子宫的手术。该患者拒绝所有网片手术。
无网片腹腔镜子宫骶骨缝合固位术（LUSSH）。
腹腔镜骶骨固定术是一种保留子宫的技术，用于治疗子宫脱垂，其治愈率高达 92%，但网片侵蚀风险高达 2.5%[1,2]。并发症导致经阴道网片重新分类为限制使用的高风险医疗器械[3,4]。骶棘韧带固定术和子宫骶骨韧带悬吊术是无网片的替代方法，但前者前间隙失败率增加，后者复发率为 20%[5,6]。腹腔镜缝合骶骨固定术已被描述，报告的成功率为 95%[7]。本视频展示了一种改良技术，为保留子宫的脱垂手术提供了一种简单、可靠且可重复的无网片方法。我们使用 2 个水平环形褥式缝线作为滑轮，使缝线均匀分布在缝线上，从而使缝线更牢固，更安全，减少撕裂的风险[8]。该技术从仔细分离骶骨岬部与子宫颈之间的腹膜开始。使用 2 根永久性缝线，从前纵韧带、子宫骶骨、子宫颈中线的环形褥式、返回途中的子宫骶骨以及最后在骶骨岬部进行缝合。通过保持子宫居中的位置，最大限度地减少子宫血管损伤。缝线在子宫操纵器施加的尾侧压力下打结，使子宫颈靠近骶骨岬部。腹膜用可吸收缝线缝合，将 Ethibond 埋入以防止暴露和肠梗阻。
手术后，子宫得到很好的支撑，阴道长度为 15cm。
