背景技术在腹腔镜骶结肠切除术(LSC)中使用聚丙烯网是盆腔器官脱垂(POP)的常用治疗方法。尽管其广泛应用,术后并发症如网状物疼痛和感染有时需要移除网状物.然而,目前尚不清楚在何种情况下需要去除网孔.我们的研究集中在网状物的the骨固定点的病理变化。我们试图评估通过经阴道自然腔道内镜手术(vNOTES)的创新方法去除的the骨网状物的病理改变。方法这项回顾性研究包括2023年在横须贺泌尿外科和泌尿外科诊所接受网片去除手术的9例患者。使用带有GelPoint访问平台的vNOTES进行拔牙手术(日本应用医疗总部,东京,日本)。非烧蚀铒YAG和钕YAG激光器(RenovaLase,SPDynamis;Fotonad.o.o.,卢布尔雅那,斯洛文尼亚)用于持续性压力性尿失禁,大便失禁,阴道糜烂,手术后出血.根据网片固定条件对患者进行分类,包括非预期的网格重叠(组I),牵引力过大(第二组),和网格老化的迹象(组III)。这种分类有助于了解与每种情况相关的不同病理结果。结果通过vNOTES去除的网状物的病理学发现在各组之间差异显著。在第一组中,观察到非典型巨细胞的特征性大液泡形成和积累,归因于网格重叠。第二组呈现液泡形成,纤维降解,过度的网状物牵引导致的组织破坏。在第三组中,网状物的老化以周围组织的裂纹和肉芽肿形成为标志。这些详细的观察结果为网状物相关疼痛和其他并发症的根本原因提供了重要的见解。强调身体对网状植入物反应的复杂性。结论这项研究证明了vNOTES用于LSC术后并发症患者的聚丙烯网片去除的有效性。导致疼痛显著减轻。病理分析表明,与网状物相关的问题源于手术技术,网格属性,和长期的身体反应。这些发现为改进网格设计和POP治疗策略提供了有价值的见解。尽管技术挑战,vNOTES推荐用于疼痛患者的网状物去除。此外,UEL的组合,VEL,有针对性的激光照射,AEL,和Nd:YAG激光治疗在管理网片去除后并发症如压力性尿失禁方面显示出有希望的结果,阴道糜烂,出血,和大便失禁,为改善患者预后提供希望。
Background The use of polypropylene mesh in laparoscopic sacrocolpopexy (LSC) is a common treatment for pelvic organ prolapse (POP). Despite its widespread application, postoperative complications such as mesh pain and infection sometimes necessitate the removal of the mesh. However, it remains unclear in which cases mesh removal is warranted. Our research focused on the pathological changes at the sacral fixation point of the mesh. We sought to evaluate the pathological alterations of the sacral mesh removed through an innovative approach of transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods This retrospective study included nine patients who underwent mesh removal surgery at the Yokosuka Urogynecology and Urology Clinic in 2023. Extraction surgery was performed using vNOTES with the GelPoint Access Platform (Applied Medical JAPAN HEADQUARTERS, Tokyo, Japan). Non-ablative Erbium YAG and Neodymium YAG lasers (RenovaLase, SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia) were utilized for persistent stress urinary incontinence, fecal incontinence, vaginal erosion, and bleeding after surgery. Patients were categorized based on mesh fixation conditions, including unintended mesh overlap (Group I), excessive traction (Group II), and signs of mesh aging (Group III). This categorization helped to understand the distinct pathological outcomes associated with each condition. Results Pathological findings from the mesh removed via vNOTES varied significantly across the groups. In Group I, characteristic large vacuole formation and accumulation of atypical giant cells were observed, attributed to mesh overlap. Group II presented with vacuole formation, fiber degradation, and tissue destruction as a result of excessive mesh traction. In Group III, the aging of the mesh was marked by cracks in the surrounding tissues and granuloma formation. These detailed observations provide crucial insights into the underlying causes of mesh-related pain and other complications, highlighting the complexity of bodily responses to mesh implants. Conclusion This study demonstrated the effectiveness of vNOTES for polypropylene mesh removal in patients with post-LSC complications, resulting in significant pain reduction. Pathological analysis revealed that mesh-related issues stem from the surgical techniques, mesh properties, and long-term bodily reactions. These findings provide valuable insights for improving mesh design and POP treatment strategies. Despite the technical challenges, vNOTES is recommended for mesh removal in patients with pain. Additionally, the combination of UEL, VEL, targeted laser irradiation, AEL, and Nd:YAG laser treatments showed promising results in managing post-mesh removal complications such as stress urinary incontinence, vaginal erosion, bleeding, and fecal incontinence, offering hope for improved patient outcomes.