Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung City, 833401, Taiwan.
Int Urogynecol J. 2022 Jul;33(7):1949-1956. doi: 10.1007/s00192-021-04934-4. Epub 2021 Aug 18.
In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS.
We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed.
The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No major complications such as bladder, ureteral, bowel injury or uncontrolled bleeding occurred in either group. Postoperative low back pain and defecation symptoms occurred exclusively in the LS group. During the follow-up period (mean 7.2 months in LP, 16.2 months in LS), none of the cases had recurrent apical prolapse.
Laparoscopic pectopexy is a feasible surgical method for apical prolapse, with a shorter operation time and less postoperative discomfort than LS. LP may overcome the steep learning curve of LS because the surgical field of LP is limited to the anterior pelvis and avoids encountering the critical organs.
除了腹腔镜骶骨阴道固定术（LS）之外，腹腔镜耻骨阴道固定术（LP）也是一种矫正中盆腔脱垂的新手术方法。通过将双侧网片末端固定在耻骨韧带上来悬挂下降的宫颈或阴道穹窿，使用合成网片将其悬吊。本研究旨在为 LP 制定学习曲线，并将其与 LS 的结果进行比较。
我们于 2019 年 8 月在我院开始开展腹腔镜/机器人耻骨阴道固定术。本回顾性研究纳入了 18 例接受 LP 治疗的初发中盆腔脱垂的连续女性患者和由同一位外科医生进行的 21 例 LS 患者。回顾了医疗和视频记录。
LP 组的年龄大于 LS 组（65.2 岁比 53.1 岁）。LP 组的手术时间明显短于 LS 组（182.9 ± 27.2 分钟比 256.2 ± 45.5 分钟，p < 0.001）。LP 学习曲线的转折点出现在第 12 例病例。两组均未发生膀胱、输尿管、肠损伤或无法控制的出血等重大并发症。术后下腰痛和排便症状仅出现在 LS 组。在随访期间（LP 组平均 7.2 个月，LS 组 16.2 个月），无任何病例出现中盆腔脱垂复发。
腹腔镜耻骨阴道固定术是一种可行的中盆腔脱垂手术方法，其手术时间短，术后不适比 LS 少。LP 可能会克服 LS 的陡峭学习曲线，因为 LP 的手术视野仅限于骨盆前区，避免遇到关键器官。
