Kotani Yasushi, Murakami Kosuke, Kanto Akiko, Takaya Hisamitsu, Nakai Hidekatsu, Matsumura Noriomi
Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan.
Gynecol Minim Invasive Ther. 2021 Apr 30;10(2):114-116. doi: 10.4103/GMIT.GMIT_1_20. eCollection 2021 Apr-Jun.
Laparoscopic sacrocolpopexy is one of the most difficult laparoscopic surgical techniques. In this study, we report on our efforts to safely perform this procedure, which consists of suturing a piece of mesh onto the anterior longitudinal ligament using a nonabsorbent suture during mesh fixation onto the prepromontorium layer, which can lead to massive bleeding if a mistake is made, by performing preoperative and intraoperative image evaluation. Preoperative contrast-enhanced computed tomography was performed. Images in DICOM format were acquired, and three-dimensional vessel reconstruction was performed. After performing a peritoneal incision in the presacral area, ultrasonography was performed using a probe inserted through a 12-mm trocar into the abdominal cavity to re-confirm the absence of vessels near the planned suturing area. After ultrasonography, an Ethibond suture was inserted through the anterior longitudinal ligament. In our hospital, 126 patients underwent the procedure, and none had a serious hemorrhage or required blood transfusion, indicating the safety of this modified procedure without separation of a wide presacral area. We believe that these techniques can be performed safely with minimal incision. However, we did not examine the efficacy of these techniques in this paper. Further studies are needed to determine whether this approach is suitable.
腹腔镜骶骨阴道固定术是最具难度的腹腔镜手术技术之一。在本研究中，我们报告了我们为安全实施该手术所做的努力，该手术包括在将补片固定到骶岬前层时，使用不可吸收缝线将一片补片缝合到前纵韧带上，若操作失误可能导致大量出血，我们通过术前和术中图像评估来进行。进行了术前对比增强计算机断层扫描。获取了DICOM格式的图像，并进行了三维血管重建。在骶前区域进行腹膜切开后，使用通过12毫米套管针插入腹腔的探头进行超声检查，以再次确认计划缝合区域附近无血管。超声检查后，将Ethibond缝线穿过前纵韧带。在我们医院，126例患者接受了该手术，无一例发生严重出血或需要输血，这表明这种改良手术在不广泛分离骶前区域的情况下是安全的。我们相信这些技术可以在最小切口的情况下安全实施。然而，我们在本文中未检验这些技术的疗效。需要进一步研究以确定这种方法是否合适。
