Yagur Yael, Kalantan Assem, Bukhari Mujahid, Donohoe Orla, Almoqren Mohammed, Robertson Jessica, Choi Sarah, Rosen David, Chen Zhuoran, Moore Kate, Chou Danny
Sydney Women's Endosurgery Centre (SWEC), St George Private Hospital, Kogarah, Sydney, NSW, Australia.
University of New South Wales, Sydney, Australia.
Int Urogynecol J. 2025 Apr;36(4):923-927. doi: 10.1007/s00192-024-06012-x. Epub 2024 Dec 5.
Sacrocolpopexy (SCP) is a recognized treatment for apical pelvic organ prolapse (POP). However, mesh erosion remains a concern, particularly when performed with concomitant hysterectomy. This video presents data on one case of a modified technique aimed at potentially minimizing mesh erosion in robotic SCP.
This technique focuses on reinforcing the vaginal cuff and using a pedicled peritoneal graft to create a tissue barrier between the mesh and the vaginal vault. Procedural steps include intrafascial colpotomy, edge-to-edge cuff closure using barbed sutures, and joining anterior and posterior meshes away from the vaginal cuff.
The surgical technique was successfully implemented in this single patient presented in the video and was performed in ten more patients with no intraoperative or postoperative complications. During the follow-up period, there were no signs of mesh erosion or exposure.
This approach emphasizing vaginal cuff strengthening and mesh separation using a pedicled peritoneal graft can be an option for reducing mesh erosion risk. This report does not provide definitive evidence that this approach reduces mesh erosion risk and further research and long-term follow-up are required to validate these findings and integrate this technique into standard management practices.
骶骨阴道固定术（SCP）是公认的治疗盆腔脏器顶端脱垂（POP）的方法。然而，网片侵蚀仍是一个问题，尤其是在同时进行子宫切除术时。本视频展示了一例改良技术的数据，该技术旨在尽可能减少机器人辅助骶骨阴道固定术中的网片侵蚀。
该技术着重于加强阴道断端，并使用带蒂腹膜移植物在网片与阴道穹窿之间形成组织屏障。手术步骤包括筋膜内阴道切开术、使用倒刺缝线进行端端断端闭合，以及在远离阴道断端处连接前后网片。
该手术技术在视频中展示的这例单一患者中成功实施，并在另外10例患者中进行，无术中或术后并发症。在随访期间，没有网片侵蚀或暴露的迹象。
这种强调使用带蒂腹膜移植物加强阴道断端和分离网片的方法可以作为降低网片侵蚀风险的一种选择。本报告并未提供确凿证据证明该方法可降低网片侵蚀风险，需要进一步研究和长期随访来验证这些发现并将该技术纳入标准管理实践中。
