Zoorob Dani, Shuffle Eric, Matkins Jay, Harmanli Oz
UroGynecology Division, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA.
Department of Obstetrics and Gynecology, ProMedica Health System, Toledo, Ohio, USA.
J Gynecol Surg. 2024 Apr 1;40(2):116-122. doi: 10.1089/gyn.2023.0120. Epub 2024 Apr 15.
This article provides a systematic approach to performing a vaginal natural-orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) to create an anatomically aligned vaginal axis, an intraoperatively adjustable apical suspension, and variable compartment tensioning.
The technique presented for vNOTES SCP focuses on: (1) retroperitoneal tunneling; (2) direct sacrum access below the S-1 level, using uterosacral-ligament guidance; (3) transvaginal tensioning of the mesh to ensure both adequate vaginal length and cuff elevation using the DZOH apical-suspension technique; (4) circumvention of intrapelvic laparoscopic suturing; and (5) near-total peritoneal coverage of the mesh arms.
This detailed description of a successful novel technique to perform vNOTES SCP was based on cadaveric experience as well as in live patients that is reproducible on living patients.
This apical suspension technique for vNOTES SCP may be a viable, reproducible, safe, and efficient transvaginal alternative to the commonly practiced minimally invasive approaches that involve abdominal-port placements. (J GYNECOL SURG 40:116).
本文提供一种系统方法，用于实施经阴道自然腔道内镜手术（vNOTES）骶骨阴道固定术（SCP），以创建解剖学上对齐的阴道轴、术中可调节的顶端悬吊以及可变的腔室张力。
所介绍的vNOTES SCP技术着重于：（1）腹膜后隧道形成；（2）在S-1水平以下使用子宫骶韧带引导直接进入骶骨；（3）使用DZOH顶端悬吊技术经阴道对网片进行张力调节，以确保足够的阴道长度和袖口抬高；（4）避免盆腔内腹腔镜缝合；（5）网片臂几乎完全被腹膜覆盖。
对成功实施vNOTES SCP的这项新技术的详细描述基于尸体经验以及活体患者经验，且可在活体患者身上重复操作。
这种用于vNOTES SCP的顶端悬吊技术可能是一种可行、可重复、安全且有效的经阴道替代方法，可替代通常采用的涉及腹部端口放置的微创方法。（《妇科手术学杂志》40:116）
