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Riparazione del pavimento pelvico Sospensione laterale LLS Dubuisson

Sospensione laterale LLS

Matrice titanizzata di Dubuisson

La patologia del pavimento pelvico è molto frequente interessando circa un terzo delle donne adulte. È fondamentale che i muscoli del pavimento pelvico mantengano una buona funzionalità, poiché la loro debolezza può predisporre a condizioni patologiche, quali il prolasso degli organi pelvici. Questa condizione patologica può essere corretta con varie tecniche chirurgiche,in questa sezione presentiamo la sospensione laterale laparoscopica mediante la rete di Dubuisson.

Rete utilizzabile con utero in sede
Mesh utilizzabile con utero in sede          
Mesh utilizzabile dopo isterectomia

Questo intervento consiste nella sospensione degli organi pelvici prolassati mediante la tunnellizazione sottoperitoneale della mesh titanizzata che viene ancorata alla parete anteriore vaginale e all’apice in caso di presenza dell’utero, quindi fissata ai muscoli laterali dell’addome. Questo intervento si esegue per via laparoscopica e consente con un unico intervento di risolvere contemporaneamente gli scivolamenti verso il basso di tutti gli organi pelvici sollevando il comparto medio.

Questa tecnica oltre a dimezzare i tempi operatori rispetto alle colposacropessi o isterosacropessi laparoscopica,  consente di evitare le possibili complicanze dovute alla preparazione e succesivo ancoraggio della rete al sacro. 

Approfondimenti scientifici

Medium-term outcomes after robotic-assisted lateral suspension with mesh for advanced multi-compartmental prolapse
2019 - Eleonora Russo, Andrea Giannini, Magdalena Montt Guevara, Paolo Mannella, Giulia Misasi, Maria Falcone, Tommaso Simoncini

Medium-term outcomes after robotic-assisted lateral suspension with mesh for advanced multi-compartmental prolapse

This study completed a prospective case series of 115 RALS to treat apical and anterior prolapse stage III or IV, with no or minimal (stage I) posterior defect. Mean follow-up was 28 ± 4 months. Primary outcomes were objective and subjective cure; secondary outcomes were reoperation rate for recurrence, erosion rate and complications. 

Results There was a significant improvement in POP-Q score in all treated compartments with an objective cure rate of 88.7% for the anterior and 93.1% for the apical compartment (p < 0.0001)

Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study
2020 - Liliana Mereu, Saverio Tateo, Maurizio Nicola D’Alterio, Eleonora Russo, Andrea Giannini, Paolo Mannella, Riccardo Pertile, Tommaso Cai, Tommaso Simoncini

The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse

A prospective cohort study on 125 patients with vaginal bulge and apical +/ anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa.

Results: 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment

Laparoscopic Lateral Suspension: Benefits of a Cross-shaped Mesh to Treat Difficult Vaginal Vault Prolapse
2020 - Jean Dubuisson, Nikolaus Veit-Rubin, Jean Bouquet de Joliniere, and Jean-Bernard Dubuisson

Laparoscopic Lateral Suspension: Benefits of a Cross-shaped Mesh to Treat Difficult Vaginal Vault Prolapse

Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.jmig.2016.01.028

Bibliografia:

Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients.Veit-Rubin N, Dubuisson JB, Lange S, Eperon I, Dubuisson J – Int Urogynecol J. 2016 Mar. PMID: 26476819

Laparoscopic lateral suspension, another way to treat genital prolapse. Dubuisson JB, Veit-Rubin N, Wenger JM, Dubuisson J – Gynecol Obstet Fertil Senol. 2017 Jan. PMID: 28238313

Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients.Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, Lange S, Eperon I, Dubuisson J – Int Urogynecol J. 2017 Nov. PMID: 28417156

Robotic-assisted apical lateral suspension for advanced pelvic organ prolapse: surgical technique and perioperative outcomes.Simoncini T, Russo E, Mannella P, Giannini A – Surg Endosc. 2016 Dec. PMID: 27287895

Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Liliana Mereua, Saverio Tateo, Maurizio Nicola D’Alterio, Eleonora Russo, Andrea Giannini, Paolo Mannella, Riccardo Pertile, Tommaso Caid, Tommaso Simoncini. 2019 European Journal of Obstetrics & Gynecology and Reproductive Biology 244 (2020) 16–20

Medium-term outcomes after robotic-assisted lateral suspension with mesh for advanced multi-compartmental prolapse. Eleonora Russo, Andrea Giannini, Magdalena Montt Guevara, Paolo Mannella, Giulia Misasi, Maria Falcone, Tommaso Simoncini. 2019 International Urogynecology Journal https://doi.org/10.1007/s00192-019-04069-7