Dällenbach Patrick
Department of Pediatrics Gynecology and Obstetrics, Division of Gynecology, Urogynecology unit, Geneva University Hospitals, Geneva, Switzerland.
Front Surg. 2022 May 12;9:898392. doi: 10.3389/fsurg.2022.898392. eCollection 2022.
Nowadays, the gold standard to treat apical pelvic organ prolapse (POP) is laparoscopic sacrocolpopexy (LSCP). However, LSCP is a difficult procedure associated with rare but potentially severe complications. Promontory dissection may expose to potential life-threatening intraoperative vascular injuries, and sacral roots or hypogastric nerve damage. There are also a few case reports of spondylodiscitis with consecutive lumbar vertebra bone erosion. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical POP repair. It lowers perioperative risks by avoiding sacral promontory preparation. Recent studies show similar anatomical and functional outcomes to LSCP, with the advantage of better preserving the vaginal axis. Moreover, LLS is well suited for hysteropexy which is important as an increasing number of women prefer uterine preservation during POP surgery. In this article, we discuss both techniques, and we share our opinion on a novel perspective in the treatment of apical POP with uterine preservation.
如今，治疗盆腔脏器顶端脱垂（POP）的金标准是腹腔镜骶骨阴道固定术（LSCP）。然而，LSCP是一项难度较大的手术，会伴有罕见但可能严重的并发症。岬部剥离可能会导致术中出现危及生命的血管损伤、骶神经根或腹下神经损伤。也有一些关于连续腰椎骨侵蚀性脊椎椎间盘炎的病例报告。带网片的腹腔镜侧方悬吊术（LLS）是修复盆腔脏器顶端脱垂的另一种技术。它通过避免骶骨岬准备来降低围手术期风险。最近的研究表明，其解剖和功能结果与LSCP相似，优点是能更好地保留阴道轴。此外，LLS非常适合子宫固定术，随着越来越多的女性在POP手术中倾向于保留子宫，这一点很重要。在本文中，我们讨论了这两种技术，并分享了我们对于保留子宫治疗盆腔脏器顶端脱垂新视角的看法。
