Nishii Shogo, Ishikawa Tetsuya, Okada Yoshiyuki, Sekizawa Akihiko
Obstetrics and Gynecology, Showa University, Tokyo, JPN.
Obstetrics and Gynecology, Female Pelvic Health Center, Showa University Northern Yokohama Hospital, Kanagawa, JPN.
Cureus. 2024 Feb 26;16(2):e54989. doi: 10.7759/cureus.54989. eCollection 2024 Feb.
Pelvic organ prolapse (POP) is prevalent among middle-aged and older women, and its prevalence is expected to increase in Japan in the future. Laparoscopic surgery for POP is covered by insurance and is currently a minimally invasive procedure. There are multiple treatment approaches for the uterus, especially sacrohysteropexy, for patients who wish to preserve their uterus. This approach requires an understanding of its anatomical characteristics, including how the arm is threaded. However, specific techniques for uterine preservation have not yet been thoroughly investigated or reported. Here, we discuss the innovative operative techniques for uterine preservation and mesh application achieved by laparoscopic sacrohysteropexy performed at our hospital. A 34-year-old woman presented at our hospital with a uterine prolapse in the hope of undergoing laparoscopic sacrohysteropexy. The anterior vaginal wall was dissected, the mesh fixed, and the right and left intrauterine foramina next to the cervix were deployed and released. The anterior vaginal wall mesh penetrated the released mesentery and was integrated with the mesh of the posterior vaginal wall. It was fixed to the anterior aspect of the cape angle by using a subperitoneal tunnel. This surgical case is currently under follow-up, with no recurrence to date. We elaborate upon the ingenious insertion site of the port for the preservation of the uterus, the secure fixation of the mesh to the uterus, and the traction method. Unlike laparoscopic sacrocolpopexy and sacrocervicopexy, laparoscopic sacrohysteropexy necessitates at least the aforementioned techniques. At our institution, we perform sacrohysteropexy following the method outlined in this case. A more efficient technique is expected to emerge as larger-scale studies accumulate additional cases, ultimately leading to widespread acceptance and standardization of the approach.
盆腔器官脱垂（POP）在中老年女性中很常见，预计未来在日本其患病率还会上升。用于POP的腹腔镜手术已纳入医保，目前是一种微创手术。对于希望保留子宫的患者，子宫有多种治疗方法，尤其是骶骨子宫固定术。这种方法需要了解其解剖特征，包括如何穿线。然而，保留子宫的具体技术尚未得到充分研究或报道。在此，我们讨论我院通过腹腔镜骶骨子宫固定术实现的保留子宫和应用补片的创新手术技术。一名34岁女性因子宫脱垂到我院就诊，希望接受腹腔镜骶骨子宫固定术。解剖阴道前壁，固定补片，展开并松解宫颈旁的左右子宫孔。阴道前壁补片穿过松解的肠系膜，与阴道后壁补片整合。通过腹膜下隧道将其固定在岬角前方。该手术病例目前正在随访中，至今无复发。我们详细阐述了保留子宫的端口巧妙插入部位、补片与子宫的牢固固定以及牵引方法。与腹腔镜骶骨阴道固定术和骶骨宫颈固定术不同，腹腔镜骶骨子宫固定术至少需要上述技术。在我们机构，我们按照本病例所述方法进行骶骨子宫固定术。随着大规模研究积累更多病例，预计会出现更有效的技术，最终使该方法得到广泛认可和标准化。
