Goueli Ramy, Rodriguez Dayron, Hess Deborah, Ganesan Vishnuvardhan, Carmel Maude
University of Texas Southwestern Medical Center, Dallas, TX.
University of Texas Southwestern Medical Center, Dallas, TX.
Urology. 2020 Sep;143:258-260. doi: 10.1016/j.urology.2020.06.006. Epub 2020 Jun 20.
Abdominal sacrocolpopexy is the gold standard for treatment of apical prolapse. Minimally invasive surgery offers many advantages over the open approach, including incision size, blood loss, postoperative pain while maintaining similar long-term outcomes. OBJECTIVE: To assess the safety and feasibility of performing a magnetic-assisted single-port robotic sacrocolpopexy (MARS).
Prior to surgery, a magnetic controller was secured to the surgical bed. The Hassan technique was used to place a 25 mm SP port through a single 2.5 cm supra-umbilical incision. A 12 mm assistant port was placed 10 cm lateral to the SP port on the right side, this additional trocar placement may be obviated by using a gel-point for both ports. The SP robot was docked on the right side of the bed. The magnet was clipped onto the sigmoid mesentery and the outer magnet was repositioned to retract the sigmoid laterally. The sacral promontory was exposed, and the peritoneal incision was carried down to the vagina. The magnet was repositioned, and the bladder was reflected off the anterior vagina. The posterior dissection was carried out to reveal the posterior vagina. "Y" mesh was placed, appropriately tensioned, secured to the sacral promontory and retroperitonealized. Cystoscopy was performed. The magnet was removed from the sigmoid colon, and all incisions were closed.
A 66-year-old G2P2 female, BMI 25, status-post prior abdominal hysterectomy presented with symptomatic stage IV prolapse. Surgery was uneventful with an operative time of 247 minutes and an estimated blood loss of 10cc. The patient was discharged the following day. At 3 months postoperatively, she had anatomic and symptomatic resolution of her prolapse.
Using magnetic assistance, MARS can be offered to women who want a durable option for prolapse repair with improved cosmesis compared to conventional methods and may offer cosmetic benefits when paired with a concurrent hysterectomy.
腹骶阴道固定术是治疗顶端脱垂的金标准。与开放手术相比，微创手术具有诸多优势，包括切口大小、失血量、术后疼痛等，同时能保持相似的长期疗效。目的：评估实施磁辅助单孔机器人骶阴道固定术（MARS）的安全性和可行性。
手术前，将磁控器固定在手术床上。采用哈森技术经脐上一个2.5厘米的切口置入一个25毫米的单孔端口。在单孔端口右侧10厘米处置入一个12毫米的辅助端口，若两个端口都使用凝胶点端口，可能无需额外置入此套管针。单孔机器人对接在手术床右侧。将磁体夹在乙状结肠系膜上，重新定位外部磁体以将乙状结肠向外侧牵拉。暴露骶岬，将腹膜切口延伸至阴道。重新定位磁体，将膀胱从阴道前壁推开。进行后间隙分离以显露阴道后壁。放置“Y”形网片，适当拉紧，固定于骶岬并腹膜化。进行膀胱镜检查。将磁体从乙状结肠上取下，关闭所有切口。
一名66岁、G2P2、BMI为25的女性，既往有腹部子宫切除术史，因症状性IV度脱垂就诊。手术过程顺利，手术时间为247分钟，估计失血量为10毫升。患者次日出院。术后3个月，其脱垂在解剖学和症状上均得到缓解。
通过磁辅助，MARS可应用于希望获得比传统方法更持久且美容效果更好的脱垂修复方案的女性，并且与同期子宫切除术联合应用时可能具有美容优势。
