Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Int Urogynecol J. 2021 May;32(5):1313-1316. doi: 10.1007/s00192-020-04536-6. Epub 2020 Sep 25.
Surgical repair of pelvic organ prolapse is one of the most frequent gynecological procedures, and its frequency is expected to increase as the population is gradually aging. Mesh use in urogynecological surgery should be limited because of important and life-treating complications. Sacral mesh-less and lateral procedures have been described as safe and effective to treat apical compartment prolapse. In this video, we describe a new laparoscopic mesh-less cervicopexy in women with symptomatic uterovaginal prolapse who did not desire uterine preservation.
Eleven women with symptomatic uterovaginal prolapse [stage 2 or higher according to the Pelvic Organ Prolapse Quantitative (POP-Q) classification system] underwent laparoscopic mesh-less cervicopexy to the sacrum and transverse fascia between May 2018 and June 2019. We performed application of the right uterosacral ligament starting from the sacrum and two semicontinous sutures including the transverse fascia, round ligament, prevescical peritoneum, pubocervical fascia and cervix that were subsequently knotted.
At 6-month follow-up, the objective success rate for apical prolapse (POP-Q score C > -1) was 90.9% (10/11 women). Only one woman presented stage 3 apical prolapse recurrence with vaginal buldge.
Laparoscopic mesh-less cervicopexy for uterovaginal prolapse seems to be a feasible surgical technique at 6-month follow-up.
盆腔器官脱垂的手术修复是最常见的妇科手术之一，随着人口逐渐老龄化，其频率预计将会增加。由于存在重要且危及生命的并发症，应限制在尿妇科手术中使用网片。已经描述了无网片的骶骨和侧方手术，这些手术对于治疗 apical 间隔脱垂是安全且有效的。在这个视频中，我们描述了一种新的腹腔镜无网片宫颈固定术，适用于有症状的子宫阴道脱垂但不希望保留子宫的女性。
2018 年 5 月至 2019 年 6 月，11 名有症状的子宫阴道脱垂女性（根据盆腔器官脱垂定量（POP-Q）分类系统，为 2 期或更高阶段）接受了腹腔镜无网片宫颈固定术至骶骨和横筋膜。我们从骶骨开始应用右侧子宫骶骨韧带，并进行两个连续缝合，包括横筋膜、圆韧带、膀胱前腹膜、耻骨宫颈筋膜和宫颈，随后打结。
在 6 个月的随访中， apical 脱垂的客观成功率（POP-Q 评分 C > -1）为 90.9%（11 名女性中的 10 名）。只有 1 名女性出现 3 期 apical 脱垂复发，伴有阴道膨出。
腹腔镜无网片宫颈固定术治疗子宫阴道脱垂在 6 个月的随访中似乎是一种可行的手术技术。
