Feasibility Analysis Of Transvaginal Single Port Laparoscopic Sacrospinous Ligament Suspension For Pelvic Organ Prolapse

Objective:To investigate the feasibility and short-term efficacy of transvaginal single port laparoscopic(V-notes)sacrospinous ligament suspension for pelvic organ prolapse.Methods:A retrospective analysis was performed on 40 cases of patients undergoing surgical treatment for pelvic organ prolapse in the gynecological ward of the Second People’s Hospital of Changzhou,Nanjing Medical University from February 2017 to October 2020.Among them,20 patients,as the study group,received transvaginal single-port laparoscopic(V-notes)sacrospinous ligament suspension.The other 20 patients as control group received traditional sacrospinous ligament suspension.SPSS.26 was used to analyze the operation duration,intraoperative blood loss,postoperative catheter extraction time,postoperative ventilation time,postoperative hospital stay,preoperative and postoperative POP-Q(quantitative staging method for pelvic organ prolapse)measurements,preoperative and postoperative pelvic dysfunction impact questionnaire(PFDI-20)scores and preoperative and postoperative pelvic cavity in the study group and control group The short form of the Questionnaire(PFIQ-7)on the impact of disease on quality of life was statistically analyzed.Results:The procedure of 40 patients was smooth,no conversion to laparotomy or additional channel was found during the operation,and no adverse reactions were found after the operation.There were no significant differences in general information,including age,body mass index(BMI),pregnancy duration,and birth duration,uterine prolapse grading between the study group and the control group.There was no statistical significance in the postoperative catheter removal time,postoperative ventilation time and postoperative hospitalization days between the two groups(P > 0.05).The intraoperative blood loss in the study group(41.50±26.21)was significantly less than that in the control group(59.80±23.80),and the difference was statistically significant(P < 0.05).However,the operation duration of the study group(183.50±45.10)was significantly higher than that of the control group(122.60±47.41)(P < 0.05).There was no statistically significant difference between the two groups in the measured values of each indicator point of POPQ before surgery,and the measured values of each indicator point of POP-Q after surgery improved significantly compared with the preoperative values,and all achieved anatomical efficacy.There was no statistically significant difference in the measured values of each indicator point of POP-Q 6 months after surgery,12 months after surgery and 24 months after surgery(P > 0.05).There was no significant difference in PFDI-20 and PFIQ-7 scores between the study group and the control group before surgery(P >0.05),PFDI-20 and PFIQ-7 scores between the two groups after surgery were significantly lower than those before surgery,which proved that the surgical effect was significant.There was no significant difference in PFDI-20 and PFIQ-7 scores at 6 months,12 months and 24 months after surgery(P > 0.05),and no recurrence occurred in 2 groups after 24 months of follow-up.Only one patient in the control group came to the hospital for gynecological examination 6 months after surgery and found inflammatory granulomatous tissue hyperplasia of the vaginal stump(1*0.8*0.5cm),and the condition was improved after symptomatic treatment.Conclusion:For female patients with moderate and severe pelvic organ prolapse,The therapeutic effect of transvaginal single-port laparoscopic sacrospinous ligament(V-notes)suspension is significant and comparable to that of traditional vaginal sacrospinous ligament(V-notes)suspension,but the amount of intraoperative bleeding is less.In addition,the surgical field of view can be better exposed,suture under direct vision,less damage to sciatic nerve,easier to stop bleeding.The operation time of transvaginal singleport laparoscopic(V-notes)group was significantly longer than that of the traditional vaginal group,which may be caused by the fact that the surgeons are not skilled in the endoscopic skills or need sufficient time to further understand the pelvic floor anatomy.With the improvement of the surgical techniques of clinicians and their full understanding of the pelvic floor anatomy,the problem of longer operation time may be significantly improved in the future.