腹腔鏡下仙骨腟固定術後の再発をロボット支援下に修復した２症例―子宮頸部固定箇所の延長による再発―

抄録

　We report two cases of recurrence after laparoscopic sacrocolpopexy for pelvic organ prolapse, in which the mesh was fixed only to the cervix; the reoperation was performed with robotic assistance.

　In both the cases, recurrence was observed residual cervical prolapse of POP-Q stage III and II at the age of 61, respectively. They were repaired by the modified French method that widely covers the vaginal wall with the assistance of a robot. The modified French style uses a single mesh for the anterior vaginal wall and sutures the posterior vaginal wall. Intraoperative findings and postoperative pathological examination revealed that the cause of recurrence was not detachment of the mesh but elongation of the cervical fixation. There have been no previous reports of this condition and caution should be exercised regarding the indications for mesh fixation only to the cervix.

　Using robotic-assistance, it was possible to isolate the mesh that was strongly adherent to the surrounding tissue and to excise the mesh from the anterior longitudinal ligament on L5-S1. The highly flexible robotic arm enables accurate incision and detachment of the mesh, which are difficult with a laparoscope, suggesting its usefulness during reoperation.