Cucinella Gaspare, Culmone Silvia, Guastella Ettore, Gentile Francesco, De Maria Francesca, Granà Roberto, Carlisi Bruno, Rotolo Stefano, Calagna Gloria
Obstetrics and Gynecology, "Villa Sofia Cervello" Hospital, University of Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy; Division of General Surgery, Fondazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Int J Surg Case Rep. 2020;77S(Suppl):S143-S146. doi: 10.1016/j.ijscr.2020.08.055. Epub 2020 Sep 4.
To report a case of uterine preservation in pelvic organ prolapse robot-assisted laparoscopic surgery.
The patient is a 42-year old Caucasian woman with pelvic organ prolapse. She previously had undergone a pelvic floor reconstruction with vaginal surgical approach, she had suffered from anorexia nervosa and she had two childbirths with vaginal deliveries. The woman was treated with robotic-assisted laparoscopic sacrohysteropexy and retropubic colposuspension.
Data suggest that abdominal surgery, typically with an abdominal sacralcolpopexy, provides better objective anatomic outcomes, than vaginal procedures, despite the longer operating times and grater delay in the resumption of activities which can be mitigated by the use of laparoscopic or robotic surgery. Several studies about vaginal approaches suggest that uterus-preserving surgery with vaginal procedures have similar success rates, less blood loss and shorter surgical time compared with hysterectomy. A multicenter study compared laparoscopic sacrohysteropexy with vaginal mesh hysteropexy reported similar one-year cure rates, improvement in pelvic floor symptoms, improvement in sexual function, and satisfaction rates.
We found robotic-assisted laparoscopic sacrohysteropexy to be a feasible and successful procedure. Combining robotic retropubic colposuspension to sacrohysteropexy is a safe and efficient approach for the treatment of stress urinary incontinence. Further studies are needed to define the standard surgical steps and confirm the efficacy and the advantages of this procedure.
报告1例盆腔器官脱垂机器人辅助腹腔镜手术中保留子宫的病例。
患者为一名42岁的白人女性，患有盆腔器官脱垂。她曾接受过阴道手术入路的盆底重建术，患有神经性厌食症，经阴道分娩2次。该女性接受了机器人辅助腹腔镜骶骨子宫固定术和耻骨后阴道悬吊术。
数据表明，尽管腹部手术（通常为腹骶阴道固定术）手术时间较长，恢复活动延迟时间较长，但通过使用腹腔镜或机器人手术可减轻这些问题，与阴道手术相比，其解剖学客观效果更好。多项关于阴道手术入路的研究表明，与子宫切除术相比，保留子宫的阴道手术成功率相似、失血量少且手术时间短。一项多中心研究比较了腹腔镜骶骨子宫固定术与阴道网片子宫固定术，报告了相似的一年治愈率、盆底症状改善情况、性功能改善情况和满意率。
我们发现机器人辅助腹腔镜骶骨子宫固定术是一种可行且成功的手术。将机器人耻骨后阴道悬吊术与骶骨子宫固定术相结合是治疗压力性尿失禁的一种安全有效的方法。需要进一步研究来确定标准手术步骤，并证实该手术的疗效和优势。
