Here we report on the surgical technique used in our first 5 patients undergoing retroperitoneal para-aortic lymphadenectomy using the robotic Da Vinci system. It is important to adapt the surgical technique using the Da Vinci Surgical System compared with the classical laparoscopic technique.
The aim of this study is to evaluate anatomical differences in vaginal length and axis between transvaginal mesh surgery (TVM) and laparoscopic sacropexy (LSC) by pelvic magnetic resonance imaging (MRI). Twenty-seven women with stage II or more symptomatic pelvic organ prolapse were involved in this study. Thirteen patients had undergone TVM, and fourteen had LSC. Preoperative and at 1 year postoperative clinical examination and dynamic MRI were performed. The angle between the vaginal axis and horizontal line or pubococcygeal line and the position of the Douglas pouch were evaluated on MRI. In clinical examination, all compartments (Aa, Ba, C, Ap, Bp, D) were significantly improved after both surgeries. Point C and D tended to be higher after LSC than TVM. In MRI assessment, the position of the Douglas was positioned significantly higher after LSC than TVM. There was no difference in postoperative vaginal axis at rest between the two surgical techniques, but the vaginal axis with maximal strain after TVM was more horizontal than LSC (LSC 143.7±6.3°vs. TVM 155.1±12.3°, p=0.003). As a result, the change of vaginal axis from at rest to maximal strain was also apparently greater after TVM. (LSC 10.3 ± 9.1°vs. TVM 20.7 ± 11.3°, p = 0.014). Both TVM and LSC significantly improved pelvic organ descent evaluated by clinical examination and MRI. LSC suspends the uterus, and Douglas pouch was significantly higher than TVM. The vaginal axis at rest leans horizontally after both surgeries, but the change of vaginal axis from at rest to maximal strain was significantly higher after TVM.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.