Davila Hugo H, Abdelhameed Sarah, Malave-Huertas Deni, Bigay F Felix, Crawford Kristy, Friedenstab Allen, Lum Katharine, Bruce Lindsey, Goodman Lindsey, Gallo Taryn
Urology and Pelvic Reconstructive Surgery, Florida Cancer Specialist and Research Institute, 3730 7th Terrace, Suite 101, Vero Beach, FL, 32960, USA.
Division of Urology and Gynecology, Department of Surgery, Cleveland Clinic Indian River Hospital, Vero Beach, Fl, USA.
J Robot Surg. 2020 Oct;14(5):759-766. doi: 10.1007/s11701-020-01051-0. Epub 2020 Feb 15.
The objective of this study was to evaluate our technique of ultrasonography and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) versus standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) in the treatment of patients with symptomatic apical/anterior vaginal prolapse. A retrospective analysis was done using the data in two community hospitals. Thirty women presented with symptomatic vaginal apical prolapse and desired minimally invasive surgery (video): (a) standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) (n = 15) or (b) ultrasound and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) (n = 15) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative staging. There was longer operating room time in the u-RALS-PFR group compared with the s-RALS group (average difference 35 min); however, sacral promontory dissection time was less in the u-RALS-PFR (average difference of 15 min). The anterior/posterior vaginal dissection and mesh tensioning time was longer in the u-RALS-PFR, as expected. There was only one surgical and anatomic failure (7%) in the s-RALS group after 6 months of surgery (POP Q = Aa + 1, Ba0, Ap-2, Bp-3, C-7). Our technique of ultrasonography and pubocervical fascia reconstruction during RALS appears to be feasible and safe. It aims to improve anterior and apical support, minimize the use of mesh and improve visualization during surgery. u-RALS-PFR approach will add some additional time during surgery but may provide better outcomes.
本研究的目的是评估我们采用超声检查及耻骨宫颈筋膜重建的机器人辅助骶骨宫颈固定术（u-RALS-PFR）与标准机器人辅助腹腔镜骶骨宫颈固定术（s-RALS）治疗有症状的阴道顶端/前壁脱垂患者的技术。利用两家社区医院的数据进行了回顾性分析。30例有症状的阴道顶端脱垂且希望接受微创手术的女性（视频）：（a）标准机器人辅助腹腔镜骶骨宫颈固定术（s-RALS）（n = 15）或（b）超声及耻骨宫颈筋膜重建的机器人辅助骶骨宫颈固定术（u-RALS-PFR）（n = 15）符合参与条件。所有参与者均接受了标准化评估，包括结构化的泌尿妇科病史及采用盆腔器官脱垂定量分期的体格检查。与s-RALS组相比，u-RALS-PFR组的手术时间更长（平均差异35分钟）；然而，u-RALS-PFR组的骶岬解剖时间更短（平均差异15分钟）。正如预期的那样，u-RALS-PFR组的阴道前后壁分离及网片张紧时间更长。s-RALS组在术后6个月仅有1例手术及解剖失败（7%）（盆腔器官脱垂定量分期系统[POP Q] = Aa + 1，Ba0，Ap-2，Bp-3，C-7）。我们在机器人辅助腹腔镜骶骨宫颈固定术中采用超声检查及耻骨宫颈筋膜重建的技术似乎可行且安全。其目的是改善前壁及顶端支撑，减少网片使用并改善手术中的视野。u-RALS-PFR方法在手术中会增加一些额外时间，但可能会带来更好的结果。
