Transvaginally Adjustable Apical Suspension and Compartment-Specific Tensioning in Vaginal Natural-Orifice Transluminal Endoscopic Surgery Sacrocolpopexy: Cadaveric and Live Patient Experience.
| Autor: | Zoorob D; UroGynecology Division, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, USA., Shuffle E; Department of Obstetrics and Gynecology, ProMedica Health System, Toledo, Ohio, USA., Matkins J; Department of Obstetrics and Gynecology, Atrium Health, Charlotte, North Carolina, USA., Harmanli O; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of gynecologic surgery [J Gynecol Surg] 2024 Apr 01; Vol. 40 (2), pp. 116-122. Date of Electronic Publication: 2024 Apr 15. |
| DOI: | 10.1089/gyn.2023.0120 |
| Abstrakt: | Objective: This article provides a systematic approach to performing a vaginal natural-orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) to create an anatomically aligned vaginal axis, an intraoperatively adjustable apical suspension, and variable compartment tensioning. Methods: The technique presented for vNOTES SCP focuses on: (1) retroperitoneal tunneling; (2) direct sacrum access below the S-1 level, using uterosacral-ligament guidance; (3) transvaginal tensioning of the mesh to ensure both adequate vaginal length and cuff elevation using the DZOH apical-suspension technique; (4) circumvention of intrapelvic laparoscopic suturing; and (5) near-total peritoneal coverage of the mesh arms. Results: This detailed description of a successful novel technique to perform vNOTES SCP was based on cadaveric experience as well as in live patients that is reproducible on living patients. Conclusions: This apical suspension technique for vNOTES SCP may be a viable, reproducible, safe, and efficient transvaginal alternative to the commonly practiced minimally invasive approaches that involve abdominal-port placements. (J GYNECOL SURG 40:116). Competing Interests: Drs. Zoorob and Matkins are surgical educators who teach vNOTES procedures for Applied Medical. No financial conflicts of interest exist for Drs. Schuffle and Harmanli. (© Dani Zoorob et al., 2024; Published by Mary Ann Liebert, Inc.) |
| Databáze: | MEDLINE |
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