Erdem Baki, Salman Süleyman, Usta Zeynep Kübra, Bacak Havva Betül, Özkan Merve Demir, Çeken Aslı Tuğçe, Işık Engin Yunus, Kumbasar Serkan, Gencer Fatma Ketenci, Baghaki Hayriye Sema, Kaçar Tevfik, Aslan Gizem Nur, Bulut Batuhan
Department of Gynecologic Oncology, The University of Mehmet Ali Aydınlar, Bakırköy Acıbadem Hospital, Halit Ziya Uşaklıgil Cad. No:1, Bakırköy, Istanbul, Turkey.
Department of Obstetrics and Gynecology, The University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.
Int Urogynecol J. 2025 Apr 1. doi: 10.1007/s00192-025-06107-z.
This video demonstrates the laparoscopic meshless pectopexy with uterine preservation (Salman's modification).
This study in a single group semi-experimental design was carried out in a secondary center. From May 2022 to April 2024, a total of 40 consecutive symptomatic women with stage 3-4 apical prolapse requesting uterine protection were included in the study. Without using mesh, patients received a laparoscopic pectopexy using monofilament non-absorbable sutures and preserving the uterus. Pelvic organ prolapses quantitative stage 2 or higher, especially in the central compartment (C ≥-1), and anatomical recurrences of genital prolapse were recorded.
In the 1st postoperative year, patients showed a significant improvement in the Pelvic Organ Prolapse Quantification central compartment (C score: mean difference -8.21 ± 3.03, 99% confidence interval -9.20 to -7.21) and in all other landmarks (p < 0.001). Apical prolapse recurrence occurred in 7.9% of cases and stage 3Bp prolapse developed in one patient during the follow-up period. Sexual function and urinary symptom scores (PISQ-12) were significantly improved after surgery.
Laparoscopic meshless pectopexy represents an effective and feasible option for the surgical treatment of uterovaginal prolapse, preserving the uterus and preventing postoperative complications associated with mesh use.
本视频展示了保留子宫的腹腔镜无网片盆底固定术（萨尔曼改良术）。
本研究采用单组半实验设计，在二级中心开展。2022年5月至2024年4月，共有40例连续的有症状的3 - 4期顶端脱垂且要求保留子宫的女性纳入研究。患者未使用网片，而是接受了使用单丝不可吸收缝线并保留子宫的腹腔镜盆底固定术。记录盆腔器官脱垂定量分期2期或更高，特别是中央隔（C≥ - 1）以及生殖器脱垂的解剖学复发情况。
术后第1年，患者盆腔器官脱垂定量中央隔（C评分：平均差值 - 8.21±3.03，99%置信区间 - 9.20至 - 7.21）以及所有其他标志点均有显著改善（p < 0.001）。随访期间，7.9%的病例出现顶端脱垂复发，1例患者发生3Bp期脱垂。术后性功能和泌尿系统症状评分（PISQ - 12）显著改善。
腹腔镜无网片盆底固定术是子宫阴道脱垂手术治疗的一种有效且可行的选择，可保留子宫并预防与使用网片相关的术后并发症。
