Bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES and considering S1–S3 nerve roots

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Natural orifice transluminal endoscopic surgery (NOTES) is a new approach in various surgical disciplines. In this paper, we present our experience of using vaginal NOTES (vNOTES) for reconstructive surgery for apical prolapse.

Objective: To describe and illustrate transluminal bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES.

Materials and methods: The study included 73 women with stage III–IV pelvic organ prolapse, according to the POP-Q classification. Surgical treatment consisted of extirpation of the uterus followed by surgical correction of pelvic organ prolapse using various methods: transluminal endoscopic fixation of the vaginal stump to the uterosacral ligaments using the vNOTES technique (46 patients), McCall culdeplasty (27 patients). The study was conducted in the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University.

Results: The advantages of vNOTES compared to traditional vaginal surgery include reduced postoperative pain, improved cosmetic effect and reduced risk of intraoperative damage to the internal organs.

Conclusion: The technical result of using this operative technique is the surgical effectiveness of fixing the vaginal stump with suturing the uterosacral ligament at a distance of 45 mm parallel to the ischium. This distance is considered to be safe in terms of the trajectory of S1–S3 nerve roots.

全文:

受限制的访问

作者简介

I. Musin

Bashkir State Medical University, Ministry of Health of Russia; Ufa City Clinical Perinatal Center

编辑信件的主要联系方式.
Email: ilnur-musin@yandex.ru
ORCID iD: 0000-0001-5520-5845

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology No. 2, Deputy Chief Physician for Obstetrics and Gynecology Care

俄罗斯联邦, Ufa; Ufa

E. Berg

Bashkir State Medical University, Ministry of Health of Russia

Email: nucleardeer@gmail.com
ORCID iD: 0000-0002-2028-7796

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2

俄罗斯联邦, Ufa

A. Yaschuk

Bashkir State Medical University, Ministry of Health of Russia

Email: alfiya_galimovna@mail.ru
ORCID iD: 0000-0003-2645-1662

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 2

俄罗斯联邦, Ufa

A. Molokanova

Ufa City Clinical Perinatal Center

Email: angella1210@mail.ru
ORCID iD: 0000-0003-1115-6775

PhD, Head of the Maternity Department

俄罗斯联邦, Ufa

G. Murtazina

Bashkir State Medical University, Ministry of Health of Russia

Email: karamelka5@inbox.ru
ORCID iD: 0000-0002-3856-8094

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2

俄罗斯联邦, Ufa

Е. Popova

Bashkir State Medical University, Ministry of Health of Russia

Email: kafedraagidpo2@mail.ru
ORCID iD: 0000-0001-7298-3489

Teaching Assistant at the Department of Obstetrics and Gynecology No. 2

俄罗斯联邦, Ufa

参考

  1. Maher C., Feiner B., Baessler K., Christmann-Schmid C., Haya N., Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst. Rev. 2016; 10(10): CD012376. https://dx.doi.org/10.1002/14651858.CD012376
  2. Barber M.D., Brubaker L., Burgio K.L., Richter H.E., Nygaard I., Weidner A.C. et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311(10): 1023-34. https://dx.doi.org/10.1001/jama.2014.1719
  3. Chene G., Tardieu A.S., Savary D., Krief M., Boda C., Anton-Bousquet M.C. et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vault prolapse after vaginal hysterectomy. Int. Urogynecol. J. 2008; 19(7): 1007-11. https://dx.doi.org/10.1007/s00192-007-0549-8
  4. Тихомиров А.Л., Геворкян М.А., Сарсания С.И. Риски спаечного процесса при хирургических вмешательствах в гинекологии и их профилактика. Проблемы репродукции. 2016; 22(6): 66-73. [Tikhomirov A.L., Gevorkian M.A., Sarsaniia S.I. The risk of postoperative adhesions in gynecology and their prevention. Russian Journal of Human Reproduction. 2016; 22(6): 66-73. (in Russian)]. https://dx.doi.org/10.17116/repro201622666-73
  5. Lowenstein L., Baekelandt J., Paz Y., Lauterbach R., Matanes E. Transvaginal natural orifce transluminal endoscopic hysterectomy and apical suspension of the vaginal cuf to the uterosacral ligament. J. Minim. Invasive Gynecol. 2019; 26(6): 1015. https://doi.org/10.1016/j.jmig.2019.04.007
  6. Maldonado P.A., Stuparich M.A., McIntire D.D., Wai C.Y. Proximity of uterosacral ligament suspension sutures and S3 sacral nerve to pelvic landmarks. Int. Urogynecol. J. 2017; 28(1): 77-84. https://dx.doi.org/10.1007/ s00192-016-3039-z
  7. Приказ Министерства здравоохранения Российской Федерации от 20.10.2020 № 1130н «Об утверждении Порядка оказания медицинской помощи по профилю "акушерство и гинекология"» (зарегистрирован 12.11.2020 № 60869). Доступно по: http://publication.pravo.gov.ru/Document/View/0001202011130037 [Order of the Ministry of Health of the Russian Federation of 20.10.2020 No. 1130n "On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology" (registered 12.11.2020 No. 60869). Available at: http://publication.pravo.gov.ru/Document/View/0001202011130037 (in Russian)].
  8. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Выпадение женских половых органов. М.; 2024. 38с. [Ministry of Health of the Russian Federation. Clinical guidelines. Female genital prolapse. Moscow; 2024. 38p. (in Russian)].
  9. Unger C.A., Walters M.D., Ridgeway B., Jelovsek J.E., Barber M.D., Paraiso M.F. Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am. J. Obstet. Gynecol. 2015; 212(5): 603.e1-603.e7. https://dx.doi.org/10.1016/j.ajog.2014.11.034
  10. Торубаров С.Ф., Духин А.О., Чмыр Е.Н. Fast track в гинекологии: реалии сегодняшнего дня. Акушерство и гинекология. 2019; 10: 60-5. [Torubarov S.F., Dukhin A.O., Chmyr E.N. Fast track in gynecology: the realities of today. Obstetrics and Gynecology. 2019; (10): 60-5 (in Russian)]. https://dx.doi.org/10.18565/aig.2019.10.60-65
  11. Мусин И.И., Ящук А.Г., Колодяжная Е.А., Насырова С.Ф., Галанова З.М., Молоканова А.Р., Имельбаева А.Г. Транслюминальная эндоскопия (vNOTES): тотальная гистерэктомия. Акушерство и гинекология. 2024; 4: 126-31. [Musin I.I., Yashchuk A.G., Kolodyazhnaya E.A., Nasyrova S.F., Galanova Z.M., Molokanova A.R., Imelbaeva A.G. Transluminal endoscopy (vNOTES): total hysterectomy. Obstetrics and Gynecology. 2024; (4): 126-31 (in Russian)]. https://dx.doi.org/10.18565/ aig.2023.305

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Anatomical definition of the ischial spines

下载 (215KB)
索引源数据
3. Fig. 2. Suturing of the uterosacral ligament with non-absorbable suture material 2-0 on both sides

下载 (674KB)
索引源数据
4. Fig. 3. Control of suturing of the uterosacral ligaments by tensioning the threads

下载 (249KB)
索引源数据
5. Fig. 4. Fixation of the vaginal dome to the uterosacral ligaments

下载 (224KB)
索引源数据
6. Рис. 5. Статическая МРТ расположения культи влагалища после транслюминальной эндоскопической фиксации культи влагалища к крестцово-маточным связкам

下载 (399KB)
索引源数据

版权所有 © Bionika Media, 2025