Sipos Attila Gergely, Kozma Bence, Farkas Bálint, Domján Zsolt, Takács Péter, Krasznai Zoárd, Lampé Rudolf
1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország.
2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Pécs Magyarország.
Orv Hetil. 2025 Aug 3;166(31):1217-1223. doi: 10.1556/650.2025.33309.
Introduction: Due to its low recurrence rate and the advantages of minimally invasive surgery, laparoscopic sacrocolpopexy has become one of the most commonly performed procedures for the treatment of apical uterovaginal prolapse. Several variations of the surgical technique exist, with the choice often reflecting the surgeon’s individual experience. However, the benefits of standardized surgical steps are indisputable in ensuring proper adaptation and safe execution of the procedure. Objective:This study aims to present the main surgical steps of laparoscopic sacrocolpopexy as applied in our clinical practice, based on the available literature and current evidence, and to analyze our clinical data. Method: Following the relevant literature, international guidelines, and our experience, the procedure was standardized into the following steps: (1) exposure of the surgical field, (2) dissection of the promontory, (3) pararectal dissection, (4) rectovaginal dissection, (5) vesicovaginal dissection, (6) supracervical hysterectomy (when indicated and the uterine corpus is present, and removal of the cervix is not justified), (7) mesh fixation to the vagina, (8) mesh fixation to the promontory, (9) peritoneal closure, (10) removal of the uterine corpus from the abdominal cavity. Results: We analyzed data from 30 laparoscopic sacrocolpopexy procedures performed at the Department of Obstetrics and Gynecology, University of Debrecen, between September 2022 and April 2023. No major intraoperative or postoperative complications occurred; deviation from the planned surgical type was required in three cases. After 6 weeks, the majority of patients reported a marked improvement in subjective prolapse symptoms. Two cases of symptomatic recurrence were identified: one managed conservatively, and one required surgical correction. No cases of de novo stress urinary incontinence were observed. Conclusion: Laparoscopic sacrocolpopexy may represent an effective surgical option for the treatment of apical uterovaginal prolapse. The application of standardized surgical steps may improve procedural safety, facilitate surgical training, and contribute to reduced operative time. Orv Hetil. 2025; 166(31): 1217–1223.
由于腹腔镜骶骨阴道固定术复发率低且具有微创手术的优势,已成为治疗子宫阴道顶端脱垂最常用的手术方法之一。该手术技术存在多种变体,其选择通常反映了外科医生的个人经验。然而,标准化手术步骤在确保手术正确实施和安全执行方面的益处是无可争议的。目的:本研究旨在根据现有文献和当前证据,介绍我们临床实践中应用的腹腔镜骶骨阴道固定术的主要手术步骤,并分析我们的临床数据。方法:根据相关文献、国际指南和我们的经验,该手术标准化为以下步骤:(1)手术视野暴露;(2)岬部解剖;(3)直肠旁解剖;(4)直肠阴道解剖;(5)膀胱阴道解剖;(6)宫颈上子宫切除术(如有指征且子宫体存在,且切除宫颈不合理时);(7)网片固定于阴道;(8)网片固定于岬部;(9)腹膜关闭;(10)从腹腔取出子宫体。结果:我们分析了2022年9月至2023年4月在德布勒森大学妇产科进行的30例腹腔镜骶骨阴道固定术的数据。未发生重大术中或术后并发症;3例需要偏离计划的手术类型。6周后,大多数患者报告主观脱垂症状有明显改善。发现2例症状复发:1例保守治疗,1例需要手术矫正。未观察到新发压力性尿失禁病例。结论:腹腔镜骶骨阴道固定术可能是治疗子宫阴道顶端脱垂的有效手术选择。标准化手术步骤的应用可能提高手术安全性,便于手术培训,并有助于缩短手术时间。《匈牙利医学周报》。2025年;166(31):1217–1223。