Togami Shinichi, Ushiwaka Takashi, Furuzono Nozomi, Kobayashi Yusuke, Nagata Chikako, Fukuda Mika, Mizuno Mika, Yanazume Shintaro, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan.
Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Kochi 780-8520, Japan.
Medicina (Kaunas). 2025 Jul 9;61(7):1242. doi: 10.3390/medicina61071242.
To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3-18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability.
评估新型非网片机器人辅助骶骨阴道固定术（RSC）使用自体圆韧带（ARL）移植物治疗盆腔器官脱垂（POP）患者的可行性和临床结局。这项回顾性研究纳入了2020年8月至2024年6月在鹿儿岛大学医院接受非网片ARL移植物RSC手术的92例患者。所有患者均符合有症状的POP-Q分期II期或更高分期的纳入标准，并选择接受非网片RSC手术。手术使用达芬奇Xi或日之鸟™手术机器人系统进行。分析了临床特征、手术数据、并发症和复发率。所有患者ARL采集均可行，非网片RSC手术顺利完成，未转为开放手术或出现任何术中并发症。中位手术时间为分钟，中位失血量为30毫升。Clavien-Dindo分级≥2级的术后并发症发生在5例患者（5%）中，所有这些患者均发生盆腔感染。1例患者（1%）出现新发压力性尿失禁。在中位随访3个月（范围3-18个月）期间，7例患者（8%）发生POP复发，所有这些患者均表现为膀胱膨出。5例患者接受了再次手术，2例接受了保守治疗。所有患者术后症状均有改善。较高的BMI和较高的POP-Q分期是复发的重要预测因素。这是关于使用ARL移植物的非网片RSC的首次报告。该手术可行且有效，避免了使用合成网片，短期结局与基于网片的RSC相当。基于ARL的RSC是一种有前景的替代方法，尤其对于有网片相关并发症风险的患者。需要长期随访以确认其耐久性。
