当院におけるロボット支援下pectopexy 16例の手術成績

抄録

Objective: Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) have become increasingly common treatments for pelvic organ prolapse (POP). However, performing sacrocolpopexy can be challenging in patients with intra-abdominal adhesions or obesity. At our institution, we have been performing pectopexy, in which a mesh is fixed to the iliopectineal ligament, as an alternative procedure in such cases. We retrospectively evaluated cases of robot-assisted pectopexy performed at our hospital to determine the usefulness of the procedure as an alternative to sacrocolpopexy.

Methods: Cases that occurred between March 2022 and July 2024 were evaluated, analyzing factors such as age, BMI, operative time, blood loss, intraoperative and postoperative complications, and recurrence of POP. Quality of life was assessed using the Japanese version of the Pelvic Floor Distress Inventory Short Form (J-PFDI-SF20).

Results: In total, 16 cases were evaluated. The median age of the patients was 74 (range: 63～79) years, and the median BMI was 24.1 (range: 18.3～35.9) kg/m². Preoperative POP-Q stages were stage II in five cases, stage III in seven cases, and stage IV in four cases. The median operative time was 145 minutes (range: 118～219), and the median blood loss was 0 ml (range: 0～120). One case of bladder injury occurred as an intraoperative complication. Postoperative POP-Q stage improved in all cases. According to the J-PFDI-SF20 assessment, scores improved from a median of 22 points (range: 9～61) preoperatively to 4.5 points (range: 3～14) at 12 months, with no recurrence observed.

Conclusion: The results of robot-assisted pectopexy at our institution were favorable, suggesting that robot-assisted pectopexy could be a useful alternative in cases where sacrocolpopexy is difficult. Further accumulation of cases and long-term evaluation of treatment outcomes are necessary.