Choi Boram, Lee Keun Ho, Kim Choonkyu, Chun Hojong, Bae Kyongtae T
Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, Republic of Korea.
Wizmedi Inc., Bucheon-Si, Gyeonggi-Do, Republic of Korea.
Int Urogynecol J. 2025 Apr 29. doi: 10.1007/s00192-025-06083-4.
Although several procedures have been developed to increase the precision and reduce the invasiveness of sacrospinous ligament fixation surgery, all surgical approaches require dissection of the vagina to access the paravaginal space and visual or tactile identification of the ligament before deploying a suture or anchor device at the ligament target site. The aim of this study was to develop and demonstrate the feasibility of a minimally invasive, needle-based treatment of vaginal apical prolapse by CT-image-guided anchoring of the vaginal vault to the sacrospinous ligament in cadavers.
A CT-image-guided, needle-based colpopexy procedure was performed on six female cadavers. After the placement of the vaginal probe, each cadaver was CT scanned to identify the target sacrospinous ligament. An anchoring device was inserted through the vaginal probe toward the target ligament. Small anchors, introduced through needle lumens via either transvaginal or transgluteal access, were implanted under the guidance of CT images to anchor the vaginal vault to the sacrospinous ligament. The cadavers were dissected and compared with CT images to evaluate the anatomical locations of the anchors with respect to the anatomical landmarks in the pelvis. Pull-out forces of the implants were also measured.
Thirty-two anchors were inserted via transvaginal access, whereas ten anchors were inserted via transgluteal access. CT images revealed that the inserted anchors were implanted in the sacrospinous ligaments (n = 40: 30 transvaginal and 10 transgluteal) or sacrotuberous ligaments (n = 2: transvaginal), as confirmed by dissection of the gluteal region of the cadavers. The mean pullout force was measured as 47.5 N ± 5.0.
We report a feasibility study for the application of novel needle-based colpopexy under CT-image guidance. Further clinical studies are required to implement this method in clinical settings and to demonstrate its safety and effectiveness compared with conventional surgical procedures.
尽管已经开发了多种程序来提高骶棘韧带固定手术的精度并减少其侵入性，但所有手术方法都需要解剖阴道以进入阴道旁间隙，并在韧带目标部位部署缝线或锚定装置之前通过视觉或触觉识别韧带。本研究的目的是开发并证明在尸体中通过CT图像引导将阴道穹窿固定至骶棘韧带进行阴道顶端脱垂的微创针式治疗的可行性。
对六具女性尸体进行了CT图像引导的针式阴道固定术。放置阴道探头后，对每具尸体进行CT扫描以识别目标骶棘韧带。通过阴道探头向目标韧带插入一个锚定装置。通过经阴道或经臀途径经针腔引入的小锚钉在CT图像引导下植入，以将阴道穹窿固定至骶棘韧带。解剖尸体并与CT图像进行比较，以评估锚钉相对于骨盆解剖标志的解剖位置。还测量了植入物的拔出力。
经阴道途径插入了32个锚钉，经臀途径插入了10个锚钉。CT图像显示，如尸体臀部区域的解剖所证实，插入的锚钉植入了骶棘韧带（n = 40：30个经阴道，10个经臀）或骶结节韧带（n = 2：经阴道）。平均拔出力测量为47.5 N±5.
