Lai Pei-Hsuan, Tsui Wing Lam, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan. (Drs. Lai, Tsui, and Ding).
Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan. (Dr. Ding).
JSLS. 2025 Apr-Jun;29(2). doi: 10.4293/JSLS.2024.00055. Epub 2025 Apr 29.
To evaluate the effectiveness and impact of the retroperitoneal tunneling technique on the surgical time and outcomes of laparoscopic sacral hysteropexy (SHP) for treating pelvic organ prolapse (POP).
This is a retrospective single-center cohort study in a tertiary referral center. Thirty-two consecutive patients underwent laparoscopic SHP for apical prolapse between 2016 and 2023. Laparoscopic SHP with or without right pelvic side wall retroperitoneal tunneling. The primary outcome was surgical time. Secondary outcomes included blood loss, intra-and postoperative complications, length of hospital stay, postoperative pain scores, and improvement in POP quantification (POP-Q) scores. Statistical analyses were performed using t-tests and multiple regression. Statistical significance was set at < .05.
The tunneling group (n = 14) demonstrated significantly shorter surgical times than the nontunneling (n = 18) group (60.79 ± 22.35 minutes vs 98.06 ± 26.28 minutes, < .001). There were no significant differences between the groups regarding blood loss, intra-and postoperative complications, length of hospital stay, pain scores, or point-C positions during 3 months and 1 year of follow-up. Multiple regression analysis confirmed a significant reduction in surgical time in the tunneling group after adjusting for confounders (-62.36 minutes [95% confidence interval (CI) = -102.7, -21.99, = .0038]).
The retroperitoneal tunneling technique in laparoscopic SHP significantly reduces the surgical time without increasing the risk of complications. These findings suggest that tunneling is a safe and efficient method that can be routinely adopted for SHP.
评估腹膜后隧道技术对腹腔镜骶骨阴道固定术（SHP）治疗盆腔器官脱垂（POP）的手术时间及疗效的影响。
这是一项在三级转诊中心进行的回顾性单中心队列研究。2016年至2023年间，32例连续性患者因顶端脱垂接受了腹腔镜SHP。采用有或无右盆腔侧壁腹膜后隧道的腹腔镜SHP。主要结局指标为手术时间。次要结局指标包括失血量、术中和术后并发症、住院时间、术后疼痛评分以及POP量化（POP-Q）评分的改善情况。采用t检验和多元回归进行统计分析。设定统计学显著性水平为<0.05。
隧道组（n = 14）的手术时间显著短于非隧道组（n = 18）（60.79 ± 22.35分钟 vs 98.06 ± 26.28分钟，<0.001）。两组在失血量、术中和术后并发症、住院时间、疼痛评分或随访3个月和1年时的C点位置方面无显著差异。多元回归分析证实，在调整混杂因素后，隧道组的手术时间显著缩短（-62.36分钟[95%置信区间（CI）= -102.7，-21.99，P = 0.0038]）。
腹腔镜SHP中的腹膜后隧道技术可显著缩短手术时间，且不增加并发症风险。这些发现表明，隧道技术是一种安全有效的方法，可常规应用于SHP。
