<meta charset="utf8"></head><body>Cercloragem laparoscópica com preservação uterina Pectopexia

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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost+of+pelvic+organ+prolapse+surgery+in+the+United+States.">Cost of pelvic organ prolapse surgery in the United States.</a> Obstet Gynecol. 98 (4), 646-651 (2001).</li><li>Seisen, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+obtained+after+robotic-assisted+laparoscopic+sacral+colpopexy+for+the+management+of+urogenital+prolapse:+a+review.">Results obtained after robotic-assisted laparoscopic sacral colpopexy for the management of urogenital prolapse: a review.</a> Prog Urol. 22 (3), 146-153 (2012).</li><li>Maher, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+women+with+apical+vaginal+prolapse.">Surgery for women with apical vaginal prolapse.</a> Cochrane Database Syst Rev. 10 (10), CD012376 (2016).</li><li>No&#233;, K. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+pectopexy:+a+prospective,+randomized,+comparative+clinical+trial+of+standard+laparoscopic+sacral+colpocervicopexy+with+the+new+laparoscopic+pectopexy-postoperative+results+and+intermediate-term+follow-up+in+a+pilot+study.">Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study.</a> J Endourol. 29 (2), 210-215 (2015).</li><li>Maher, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+women+with+apical+vaginal+prolapse.">Surgery for women with apical vaginal prolapse.</a> Cochrane Database Syst. Rev. 7 (7), CD012376 (2023).</li><li>Zhang, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+non-mesh+cerclage+pectopexy+for+pelvic+organ+prolapse.">Laparoscopic non-mesh cerclage pectopexy for pelvic organ prolapse.</a> J Vis Exp. (187), e64388 (2022).</li><li>Korbly, N. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+preferences+for+uterine+preservation+and+hysterectomy+in+women+with+pelvic+organ+prolapse.">Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.</a> Am J Obstet Gynecol. 209 (5), 470.e1-470.e6 (2013).</li><li>Meriwether, K. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Uterine+preservation+vs+hysterectomy+in+pelvic+organ+prolapse+surgery:+a+systematic+review+with+meta-analysis+and+clinical+practice+guidelines.">Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines.</a> Am J Obstet Gynecol. 219 (2), 129-146.e2 (2018).</li><li>Zeng, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Introduction+of+intracapsular+rotary-cut+procedures+(IRCP):+A+modified+hysteromyomectomy+procedures+facilitating+fertility+preservation.">Introduction of intracapsular rotary-cut procedures (IRCP): A modified hysteromyomectomy procedures facilitating fertility preservation.</a> J Vis Exp. (143), e58410 (2019).</li><li>Srikrishna, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+Patient+Global+Impression+of+Improvement+(PGI-I)+for+urogenital+prolapse.">Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse.</a> Int Urogynecol J. 21 (5), 523-528 (2010).</li><li>Occhino, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+visual+analog+scale+form+of+the+pelvic+organ+prolapse/urinary+incontinence+sexual+function+questionnaire.">Validation of a visual analog scale form of the pelvic organ prolapse/urinary incontinence sexual function questionnaire.</a> Female Pelvic Med ReconstrSurg. 17 (5), 246-248 (2011).</li><li>Barber, M. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pelvic+floor+disorders+network.+Defining+success+after+surgery+for+pelvic+organ+prolapse.">Pelvic floor disorders network. Defining success after surgery for pelvic organ prolapse.</a> Obstet Gynecol. 114 (3), 600-609 (2010).</li><li>Smith, F. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lifetime+risk+of+undergoing+surgery+for+pelvic+organ+prolapse.">Lifetime risk of undergoing surgery for pelvic organ prolapse.</a> Obstet Gynecol. 116 (5), 1096-1100 (2010).</li><li>Sarlos, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+sacrocolpopexy+for+uterine+and+post-hysterectomy+prolapse:+anatomical+results,+quality+of+life+and+perioperative+outcome-a+prospective+study+with+101+cases.">Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases.</a> Int Urogynecol J Pelvic Floor Dysfunct. 19 (10), 1415-1422 (2008).</li><li>Banerjee, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=a+new+technique+of+prolapse+surgery+for+obese+patients.">a new technique of prolapse surgery for obese patients.</a> Arch Gynecol Obstet. 284 (3), 631-635 (2011).</li><li>Szymczak, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+laparoscopic+techniques+for+apical+organ+prolapse+repair+-+a+systematic+review+of+the+literature.">Comparison of laparoscopic techniques for apical organ prolapse repair - a systematic review of the literature.</a> Neurourol Urodyn. 38 (8), 2031-2050 (2019).</li><li>Obut, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+the+quality+of+life+and+female+sexual+function+following+laparoscopic+pectopexy+and+laparoscopic+sacrohysteropexy+in+apical+prolapse+patients.">Comparison of the quality of life and female sexual function following laparoscopic pectopexy and laparoscopic sacrohysteropexy in apical prolapse patients.</a> Gynecol Minim Invasive Ther. 10 (2), 96-103 (2021).</li><li>Chan, C. Y. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+the+surgical+management+of+apical+pelvic+organ+prolapse.">A systematic review of the surgical management of apical pelvic organ prolapse.</a> Int Urogynecol J. 34 (4), 825-841 (2023).</li><li>Anglim, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+do+patients+and+surgeons+decide+on+uterine+preservation+or+hysterectomy+in+apical+prolapse.">How do patients and surgeons decide on uterine preservation or hysterectomy in apical prolapse.</a> Int Urogynecol J. 29 (8), 1075-1079 (2018).</li><li>Kostov, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corona+mortis,+aberrant+obturator+vessels,+accessory+obturator+vessels:+clinical+applications+in+gynecology.">Corona mortis, aberrant obturator vessels, accessory obturator vessels: clinical applications in gynecology.</a> Folia Morphol (Warsz). 80 (4), 776-785 (2021).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>5 mm trocars</td>
			<td>KARL STORZ, Germany</td>
			<td>30160X</td>
			<td>Endoscopic equipment</td>
		</tr>
		<tr>
			<td>10 mm trocars&#160;</td>
			<td>KARL STORZ, Germany</td>
			<td>30160 H2</td>
			<td>Endoscopic equipment</td>
		</tr>
		<tr>
			<td>Cefuroxime sodium for injection&#160;</td>
			<td>YOUCARE , China</td>
			<td>H20063758</td>
			<td>Prophylactic antibiotics</td>
		</tr>
		<tr>
			<td>Enoxaparin sodium for injection&#160;</td>
			<td>TECHDOW , China</td>
			<td>H20056847</td>
			<td>Perioperative thrombosis prophylaxis</td>
		</tr>
		<tr>
			<td>Ethibond size 2</td>
			<td>ETHICON, USA</td>
			<td>X519H&#160;</td>
			<td>Nonabsorbable braided polyester</td>
		</tr>
		<tr>
			<td>VICRYL 2-0</td>
			<td>ETHICON, USA</td>
			<td>VCP317H</td>
			<td>Absorbable braided suture</td>
		</tr>
	</tbody>
</table>

laparoscopic non-mesh cerclage pectopexy with uterine preservation for pelvic organ prolapse

Pelvic organ prolapse (POP) significantly impacts the well-being of a substantial portion of parous women over 50 years old1. With an increasing average lifespan, a higher number of women will require POP surgery. The gold standard for treating uterine prolapse is laparoscopic sacrocolpopexy (LS), in which the vaginal apex is attached to the sacrum over the third and fourth sacral vertebrae using mesh, boasting a success rate exceeding 95% and long-term durability2. However, LS is a challenging procedure commonly associated with postoperative defecation problems3. Additionally, LS may not be suitable for obese patients. Laparoscopic pectopexy (LP), in which the iliopectineal ligaments are used for a bilateral mesh fixation of vaginal vault or cervical stump, has emerged as a viable alternative to LS for addressing apical prolapse, due to comparable clinical efficacy and a lower incidence of defecation disorders4.
However, the usage of synthetic mesh for apical support in LS and LP causes mesh-related complications, increasing patient suffering and medical expenses5. Our team has published a new procedure called laparoscopic non-mesh cerclage pectopexy (LNMCP), embedding permanent cervical cerclage sutures in the round ligament until the iliopectineal ligament. This was successfully performed with high objective and subjective success rates6. Recent evidence suggests that many women with prolapse issues desire to preserve their uterus, which is paramount for maintaining self-confidence, self-esteem, and a sense of femininity7.
The current research reports the development of a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation for POP (LNMCPUP) for addressing apical prolapse. This novel technique involves embedding cervical cerclage sutures in the round ligament until the iliopectineal ligament, resulting in a firm uterine suspension. In addition, without using synthetic mesh, this procedure obviates mesh erosion while reducing medical costs. Moreover, this procedure ensures that the uterus is preserved, thereby minimizing perioperative risks associated with hysterectomy and eliminating significant alterations in POP surgery outcomes8.

<meta charset="utf8"></head><body>Autor em destaque: Avançando no tratamento do prolapso pélvico com uma abordagem sem malha usando pectopexia laparoscópica

Pectopexia de cerclagem laparoscópica sem malha com preservação uterina para prolapso de órgãos pélvicos

A laparoscopic non-mesh cerclage pectopexy with a uterine preservation is developed to treat poor patients who wish to preserve their uterus, which eliminate mesh, lowering complications. The usage of synthetic mesh for IPL support in PUP surgery caused mesh-related complications, increasing patient suffering and medical expenses. LMCPUP integrates cervical cerclage and laparoscopic pectopexy without using mesh, resulting in a form new chain suspect, while also eliminating the risk of mesh erosion and lowering healthcare costs.

Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for ...

laparoscopic-non-mesh-cerclage-pectopexy-with-uterine-preservation

Research

JoVE Journal

Medicine

Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse

432 Views.  The University of Hong Kong-Shenzhen Hospital. A laparoscopic non-mesh cerclage pectopexy with a uterine preservation is developed to treat poor patients who wish to preserve their uterus, which eliminate mesh, lowering complications. The usage of synthetic mesh for IPL support in PUP surgery caused mesh-related complications, increasing patient suffering and medical expenses. LMCPUP integrates cervical cerclage and laparoscopic pectopexy without using mesh, resulting in a form new chain suspect, while also eliminating the risk of mesh er...