<meta charset="utf8"></head><body>Livmoderbevarande laparoskopisk cerklagepektopexi

<ol>
	<li>Subak, L. 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>Författare Spotlight: Främja behandling av bäckenprolaps med en icke-mesh-metod med hjälp av laparoskopisk pektopexi

Laparoskopisk icke-mesh cerklagepektopexi med livmoderbevarande för bäckenorganprolaps

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

348 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...

Video: Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy

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This article describes how to conduct minimal erythema dose (MED) testing in order to determine the lowest dose of ultraviolet radiation that will cause erythema (burning) when administered to an...

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the arteriovenous (av) loop in a small animal model to study angiogenesis and vascularized tissue engineering

The Arteriovenous AV Loop in a Small Animal Model to Study Angiogenesis and Vascularized Tissue Engineering

We describe a microsurgical approach for the generation of an arteriovenous (AV) loop as a model for analyzing vascularization in vivo in an isolated and well-characterized environment. This model is not only useful for the investigation of angiogenesis, but is also optimally suited for engineering axially vascularized and transplantable...

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Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is used to establish dosage schedules for ultraviolet radiation phototherapy. It can assess individual variation in inflammatory response but lacks methodology for achieving reproducible results. Here, we present a precision implementation of MED and demonstrate its ability to capture individual variation in inflammatory...

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response

Author Spotlight: Advancing Pelvic Prolapse Treatment with a Non-Mesh Approach using Laparoscopic Pectopexy

Here we introduce a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation for pelvic organ prolapse (LNMCPUP) for patients who wish to preserve their uterus. Permanent cerclage sutures are used to suspend the uterus to the iliopectineal ligament through the round ligament.

Uterine-Preserving Laparoscopic Cerclage Pectopexy 

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Roux-en-Y Gastric Bypass Operation in Rats

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental...

laparoscopic non-mesh cerclage pectopexy for pelvic organ prolapse

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

The present pilot study describes the development of laparoscopic non-mesh cerclage pectopexy to treat pelvic organ prolapse. The procedure can be used to prevent any complications associated with the use of...

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En Face Preparation of Mouse Blood Vessels

A procedure for making en face preparations of the mouse carotid artery and aorta is described. Such preparations, when immunofluorescently stained with specific antibodies, enable us to study localization of proteins and identification of cell types within the entire vascular wall by confocal...

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Transvaginal Mesh Insertion in the Ovine Model

This protocol describes mesh implantation in the ovine rectovaginal septum using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms.

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Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

Robotic central pancreatectomy may be used in selected patients in experienced centers. This protocol presents all steps and the feasibility of a robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy in a 16-year-old adolescent patient.

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Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection 

Real-time polymerase chain reaction (PCR)-based detection and quantification of hepatitis B virus (HBV) DNA is a sensitive and accurate method for diagnosing and monitoring HBV infection. Here, we present a protocol for HBV DNA detection and the viral load measurement of a...

Detection and Quantification of Hepatitis B Virus DNA in Human Serum

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non-mesh laparoscopic pectopexy with uterine retention for pelvic organ prolapse

Non-Mesh Laparoscopic Pectopexy with Uterine Retention for Pelvic Organ Prolapse

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Creating Dynamic Images of Short-lived Dopamine Fluctuations with lp-ntPET:  Dopamine Movies of Cigarette Smoking

We present a novel PET imaging approach for capturing dopamine fluctuations induced by cigarette smoking.  Subjects smoke in the PET scanner. Dynamic PET images are modeled voxel-by-voxel in time by lp-ntPET, which includes a time-varying dopamine term. The results are 'movies' of dopamine fluctuations in the striatum during...

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The Subventricular Zone En-face: Wholemount Staining and Ependymal Flow

The lateral ventricle walls contain the largest germinal region in the adult mammalian brain.  Traditionally, studies on neurogenesis in this region have relied on classical sectioning techniques for histological analysis.  Here we present an alternative approach, the wholemount technique, which provides a comprehensive, en-face view of this germinal...

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Using En Face Immunofluorescence Staining to Observe Vascular Endothelial Cells Directly

Here, we present a protocol for immunofluorescence staining to observe the endothelial cells of the mouse aorta directly. This technique is useful when studying the cellular and molecular phenotype of endothelial cells in different flow patterns and in the development of...

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Syringe-injectable Mesh Electronics for Stable Chronic Rodent Electrophysiology

Mesh electronics probes seamlessly integrate and provide stable, long-term, single-neuron level recording within the brain. This protocol uses mesh electronics for in vivo experiments, involving the fabrication of mesh electronics, loading into needles, stereotaxic injection, input/output interfacing, recording experiments, and histology of tissue containing mesh...

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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

Presented here is a method for improving the mesh placement in laparoscopic incisional hernia repair, which can shorten the time required for mesh fixation and reduce the occurrence of postoperative chronic...

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Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

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A Performance-testing Platform for a Conduction Micropump with an FR-4 Copper-clad Electrode Plate

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Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for treating POP. Recent research has increasingly validated the efficacy and safety of laparoscopic pectopexy (LP) for addressing apical POP. However, the cost of synthetic mesh and associated complications restrict the widespread use of this technique. Our team previously published a study describing a novel, non-mesh procedure called laparoscopic non-mesh cerclage pectopexy (LNMCP), demonstrating successful outcomes with satisfactory objective and subjective success rates. Many patients express a preference for retaining their uterus during prolapse surgery due to considerations related to sexuality, partnership, and body image. 
The present research introduces a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation (LNMCPUP) for POP, wherein the uterus is suspended to the iliopectineal ligament through the round ligament using permanent cerclage sutures. We successfully performed this procedure in 14 cases at our hospital, six of whom still had menstruation, and the remaining eight were postmenopausal, with a mean operation time of 54.43 min (&plusmn; 10.18 min) and an average bleeding volume of 53.57 mL (&plusmn; 48.77 mL). The mean follow-up duration was 19.71 &plusmn; 15.87 months. The objective success rate of LNMCPUP was 100%, with a subjective success rate of 92.86%. No significant complications were observed during or after surgery. LNMCPUP integrates cervical cerclage and shortening of the round ligament, as well as LP without using mesh, thereby eliminating the risk of mesh erosion and lowering healthcare costs. Moreover, this novel technique is relatively easy to master, making it accessible even in rural and underdeveloped areas where synthetic mesh is unavailable. Therefore, it is worthwhile to adopt LNMCPUP in POP patients who desire the preservation of their uterus.

Here we introduce a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation for pelvic organ prolapse (LNMCPUP) for patients who wish to preserve their uterus. Permanent cerclage sutures are used to suspend the uterus to the iliopectineal ligament through the round ligament.

To begin the laparoscopic bilateral Salpingo-Oophorectomy use an electrosurgical tool to coagulate the round ligament and sever it. Open the vesical uterine recursion peritoneum to expose the uterine artery. To perform cervical isthmic cerclage start at the four o'clock position on the right side and proceed counterclockwise.Continue in a circular motion around the cervix until reaching the starting point. Expose the ileal pectineal ligament and make an incision in the peritoneum. Using surgical tools, detach the surrounding soft tissue between the lateral umbilical ligament and the round ligament.Using a permanent suture of size two, suture ligate and attach the round ligament to the cervical isthmus. Embed the permanent suture into the round ligament ending at the ileal pectineal ligament. Insert the stitch through the ileal ligament and confirm suspension without tension.Next, repeat the process on the other side of the pelvis. Finally, perform reperitonealization. The laparoscopic non mesh pectopexy with uterine preservation was performed successfully in 14 patients with an objective success rate of 100%The subjective success rate assessed with the patient global impression was 92.86%No complications were reported during the follow-up period, which had an average duration of approximately 19.71 months.