Welch Eva K, Dengler Katherine L, Gisseman Jordan, Gruber Daniel D
Division of Urogynecology, Walter Reed National Military Medical Center (Drs. Welch, Dengler, and Gisseman), Bethesda, Maryland.
Division of Urogynecology, Walter Reed National Military Medical Center (Drs. Welch, Dengler, and Gisseman), Bethesda, Maryland.
J Minim Invasive Gynecol. 2025 Jan;32(1):12-13. doi: 10.1016/j.jmig.2024.07.015. Epub 2024 Jul 23.
To review advances of the sacrocolpopexy procedure and demonstrate the Vaginal-Assisted Laparoscopic Sacrocolpopexy approach.
Participants who underwent the Vaginal-Assisted Laparoscopic Sacrocolpopexy approach and consented to intra-operative video documentation were included.
This research was conducted at a single academic institution.
Sacrocolpopexy is an abdominal apical suspension that involves placement of mesh between the vaginal apex and anterior longitudinal ligament overlying the S1-S2 vertebrae. Vaginal Assisted Laparoscopic Sacrocolpopexy (VALS), is a modified approach to sacrocolpopexy. After the hysterectomy, the mesh is attached vaginally to the anterior and posterior vaginal walls. Vaginal dissection of the vesicovaginal and rectovaginal spaces by hand is quick and efficient and allows for palpation of needle depth, which can prevent suture tearing and inadequate mesh attachment with non-tactile placement. The surgeon then transitions back to laparoscopy to complete the remainder of the procedure. Recent literature demonstrates similar rates of mesh complications and reoperation for prolapse with concurrent total hysterectomy versus supracervical hysterectomy given the transition to type I polypropylene mesh and reduction in permanent suture use for vaginal mesh attachment. We anticipate an increase in utilization of the VALS technique given multiple benefits of total hysterectomy, including reduced risk of postoperative menses in premenopausal patients, less postoperative pain and better cosmetic outcomes without need for mini-laparotomy or port-site extension for uterine morcellation, and decreased cervical and endometrial cancer risk. Surgical benefits of the VALS technique include shorter anesthesia and operative time and reduces the need for higher level assistance intraoperatively. VALS is also more ergonomic for the surgeon, promoting use of different muscles throughout the case, thus decreasing muscle fatigue and risk of repetitive motion injury.
Laparoscopic sacrocolpopexy utilizing transvaginal mesh attachment is another tool in the myriad of techniques to treat advanced pelvic organ prolapse. This technique reduces operative and anesthesia time, minimizes mesh complications while maintaining successful outcomes for patients. VIDEO ABSTRACT.
回顾骶骨阴道固定术的进展，并展示阴道辅助腹腔镜骶骨阴道固定术的方法。
纳入接受阴道辅助腹腔镜骶骨阴道固定术并同意术中视频记录的参与者。
本研究在单一学术机构进行。
骶骨阴道固定术是一种经腹顶端悬吊术，涉及在阴道顶端与覆盖S1 - S2椎体的前纵韧带之间放置补片。阴道辅助腹腔镜骶骨阴道固定术（VALS）是骶骨阴道固定术的一种改良方法。子宫切除术后，补片经阴道附着于阴道前壁和后壁。通过手动在阴道内分离膀胱阴道间隙和直肠阴道间隙快速且有效，并且能够触诊针的深度，这可以防止缝线撕裂以及因非触觉放置导致补片附着不充分。然后外科医生再转换回腹腔镜完成手术的其余部分。近期文献表明，鉴于向I型聚丙烯补片的转变以及减少用于阴道补片附着的永久缝线使用，同期全子宫切除术与次全子宫切除术相比，补片并发症和脱垂再次手术的发生率相似。鉴于全子宫切除术有多种益处，包括降低绝经前患者术后月经的风险、减轻术后疼痛以及改善美容效果，无需小切口剖腹术或为子宫粉碎术延长端口部位，以及降低宫颈癌和子宫内膜癌风险，我们预计VALS技术的应用将会增加。VALS技术的手术益处包括缩短麻醉和手术时间，并减少术中对高级别辅助的需求。VALS对外科医生来说也更符合人体工程学，在整个手术过程中促进使用不同的肌肉，从而减少肌肉疲劳和重复性运动损伤的风险。
利用经阴道补片附着的腹腔镜骶骨阴道固定术是治疗重度盆腔器官脱垂众多技术中的另一种工具。该技术减少了手术和麻醉时间，将补片并发症降至最低，同时为患者维持成功的治疗效果。视频摘要。
