Koensgen Dominique, Lukannek Charlotte, Schroeder Carolin, Otten Lucia A, Hornemann Amadeus, Mustea Alexander
Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg - Campus 1, 5312, Bonn, Germany.
Department of Gynecology, Bürgerspital, Frankfurt Am Main, Germany.
J Med Case Rep. 2025 May 26;19(1):253. doi: 10.1186/s13256-025-05267-2.
The management of pelvic organ prolapse remains a clinical challenge, particularly with concerns regarding the safety of synthetic mesh-based procedures. In response, we present a novel approach for apical prolapse repair utilizing robotic assistance for tendon transplantation, offering a promising alternative to the use of synthetic meshes.
A 47-year-old multiparous woman (white, non-Hispanic) with a history of three vaginal deliveries and laparoscopic supracervical hysterectomy presented with symptoms of pelvic organ prolapse, including vaginal discomfort, recurrent urinary tract infections, and overactive bladder. Clinical examination and ultrasonography revealed a combined anterior and apical vaginal prolapse grade II according to the Pelvic Organ Prolapse Quantification system. A robotic sacrocervicopexy with a semitendinosus autograft, harvested from the left popliteal fossa, and concomitant anterior colporrhaphy were performed. The surgical procedure included the dissection of the ligamentum longitudinale using a nerve-sparing technique, cervix preparation, and tendon transplantation. The surgery lasted 172 min without intraoperative complications. The patient's postoperative recovery was swift without residual prolapse, voiding dysfunction, or urinary incontinence reported at any of the follow-up examinations, conducted at 8 weeks, 3 months, 6 months, and 1 year after the operation.
This case report demonstrates the successful application of a robotic-assisted tendon transplantation approach for apical prolapse repair, offering a safe and effective alternative to synthetic mesh-based surgical procedures. An ongoing multicenter registry study aims to further validate the method's safety and efficacy, paving the way for its broader adoption in clinical practice.
盆腔器官脱垂的治疗仍然是一项临床挑战，尤其是在合成网片手术的安全性方面存在担忧。作为回应，我们提出了一种利用机器人辅助进行肌腱移植修复顶端脱垂的新方法，为合成网片的使用提供了一种有前景的替代方案。
一名47岁的经产妇（白人，非西班牙裔），有三次阴道分娩和腹腔镜子宫次全切除术史，出现盆腔器官脱垂症状，包括阴道不适、复发性尿路感染和膀胱过度活动症。根据盆腔器官脱垂量化系统，临床检查和超声检查显示阴道前壁和顶端联合脱垂Ⅱ度。进行了机器人辅助的骶子宫固定术，使用从左腘窝采集的半腱肌自体移植物，并同时进行了阴道前壁修补术。手术过程包括使用保留神经技术解剖纵韧带、宫颈准备和肌腱移植。手术持续了172分钟，无术中并发症。患者术后恢复迅速，术后8周、3个月、6个月和1年进行的任何随访检查均未报告残留脱垂、排尿功能障碍或尿失禁。
本病例报告证明了机器人辅助肌腱移植方法在顶端脱垂修复中的成功应用，为基于合成网片的手术提供了一种安全有效的替代方案。一项正在进行的多中心注册研究旨在进一步验证该方法的安全性和有效性，为其在临床实践中的更广泛应用铺平道路。
