骨盤臓器脱に対する全腹腔鏡下仙棘靭帯固定・腟壁形成術：症例報告

抄録

Introduction
  Surgical procedures using meshes for pelvic organ prolapse repair have been reported to cause various complications such as mesh extrusion. Transvaginal sacrospinous ligament fixation without mesh is a useful surgical procedure; however, the surgical field is narrow, making it difficult to perform. Therefore, a procedure that allows the safe identification and suture of the sacrospinous ligament is desirable. In this study, we report a surgical procedure that we developed for laparoscopic sacrospinous ligament fixation and colporrhaphy.

Case report
  The patient was aged 76 years and had a Pelvic Organ Prolapse Quantification System (POP-Q) stage III uterine prolapse, concomitant with a left ovarian tumor. Using a laparoscopic technique, we performed supracervical hysterectomy, bilateral salpingo-oophorectomy, sacrospinous ligament fixation, and colporrhaphy. No complications occurred during surgery, and the patient has shown no recurrence of pelvic organ prolapse 3 months after the procedure.

Conclusion
  Our experience with the present case indicates that sacrospinous ligament fixation and colporrhaphy can be successfully performed laparoscopically. Transvaginal and laparoscopic cerclage techniques using the uterosacral ligaments have been previously reported; however, because the uterosacral ligaments are membranous structures, the fixation site has varied among surgeons. On the other hand, the sacrospinous ligament is sufficiently strong for suturing, and fixation strength does not vary among surgeons. Therefore, we believe that the surgical procedure described in this study can be used as a standard surgical technique for laparoscopic pelvic organ prolapse repair without mesh.