机器人辅助与微型腹腔镜阴道骶骨固定术治疗盆腔器官脱垂:一项回顾性观察队列研究及法医学视角

Robotic versus Mini-Laparoscopic Colposacropexy to Treat Pelvic Organ Prolapse: A Retrospective Observational Cohort Study and a Medicolegal Perspective.

作者信息

Billone Valentina, Gullo Giuseppe, Perino Girolamo, Catania Erika, Cucinella Gaspare, Ganduscio Silvia, Vassiliadis Alessandra, Zaami Simona

机构信息

Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy.

Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy.

出版信息

J Clin Med. 2024 Aug 15;13(16):4802. doi: 10.3390/jcm13164802.

Abstract

: POP (pelvic organ prolapse) involves the descent of one or more pelvic organs downwards with or without protrusion from the vaginal opening, caused by the relaxation and weakening of ligaments, connective tissue, and pelvic muscles. Such an outcome negatively impacts the quality of life. The gold standard procedure for repairing apical compartment prolapse is colposacropexy (CS) to secure the anterior and posterior walls of the vagina to the anterior longitudinal sacral ligament, located anteriorly to the sacral promontory, using a mesh. Several surgical approaches are feasible. Laparotomic or minimally invasive methods, including laparoscopic or robotic ones, can restore the horizontal axis of the vagina and typically involve concomitant hysterectomy. : This study is based on 80 patients who underwent CS at Palermo's Ospedali Riuniti Villa Sofia-Cervello from 2019 to 2023. Women aged 35-85 at the time of surgery were divided into two groups: 40 patients underwent mini-laparoscopic surgery, and 40 patients underwent robotic surgery. The following parameters were accounted for: demographic data (initials of name and surname, age), preoperative clinical diagnosis, date of surgery, surgical procedure performed, estimated intraoperative blood loss, duration of surgical intervention, length of hospital stay, postoperative pain assessed at 24 h using the VAS scale, and any complications occurring in the postoperative period. Mini-laparoscopic CS (Minilap) and robotic CS (Rob) were then compared in terms of outcomes. : In the Minilap group, 11 patients out of 40 had a preoperative diagnosis of vaginal vault prolapse. The average age in this group was 61.6. Five of these patients had isolated cystocele, while the rest presented vaginal stump prolapse linked to cystocele, rectocele, or both. The remaining 29 patients in the Minilap group had a preoperative diagnosis of uterovaginal prolapse, also associated with cystocele, rectocele, or both, or isolated in nine cases. In the Rob group (average age: 60.1), 13 patients were diagnosed with vaginal prolapse (isolated or associated with cystocele), while the remaining 27 had a diagnosis of uterovaginal prolapse. In the Minilap group, the average procedure duration was 123.3 min, shorter than the Rob group (160.1 min). The data collected throughout this prospective study point to the mini-laparoscopic approach as being preferable over the robotic one in terms of surgical procedure length, intraoperative blood loss, postoperative pain, and aesthetic outcome. Hospital stay duration and post operative complication rates were similar for both groups. The innovative and ever-progressing nature of such procedures calls for novel standards prioritizing patient care as well as medicolegal viability.

摘要

盆腔器官脱垂(POP)是指一个或多个盆腔器官向下移位,伴有或不伴有从阴道口突出,这是由韧带、结缔组织和盆腔肌肉的松弛和减弱引起的。这种情况会对生活质量产生负面影响。修复顶端盆腔脱垂的金标准手术是阴道骶骨固定术(CS),即使用网片将阴道的前后壁固定于骶岬前方的骶前纵韧带。有几种手术方法可行。剖腹手术或微创方法,包括腹腔镜或机器人辅助手术,可恢复阴道的水平轴,通常还会同时进行子宫切除术。

本研究基于2019年至2023年在巴勒莫的索菲亚 - 切维罗联合医院接受CS手术的80例患者。手术时年龄在35 - 85岁的女性被分为两组:40例患者接受了迷你腹腔镜手术,40例患者接受了机器人辅助手术。记录了以下参数:人口统计学数据(姓名首字母和姓氏、年龄)、术前临床诊断、手术日期、所实施的手术程序、估计术中失血量、手术干预持续时间、住院时间、术后24小时使用视觉模拟评分法(VAS)评估的疼痛程度以及术后出现的任何并发症。然后比较了迷你腹腔镜CS(Minilap)和机器人辅助CS(Rob)的手术结果。

在Minilap组中,40例患者中有11例术前诊断为阴道穹窿脱垂。该组的平均年龄为61.6岁。其中五例患者患有孤立性膀胱膨出,其余患者表现为与膀胱膨出、直肠膨出或两者相关的阴道残端脱垂。Minilap组其余29例患者术前诊断为子宫阴道脱垂,也与膀胱膨出、直肠膨出或两者相关,或在九例中为孤立性脱垂。在Rob组(平均年龄:60.1岁)中,13例患者被诊断为阴道脱垂(孤立性或与膀胱膨出相关),其余27例诊断为子宫阴道脱垂。在Minilap组中,平均手术持续时间为123.3分钟,短于Rob组(160.1分钟)。 这项前瞻性研究收集的数据表明,在手术时间、术中失血量、术后疼痛和美观效果方面,迷你腹腔镜手术方法优于机器人辅助手术方法。两组的住院时间和术后并发症发生率相似。此类手术的创新性和不断进步的性质要求制定新的标准,将患者护理以及法医学可行性放在首位。

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