Результаты исследований: Научные публикации в периодических изданиях › статья › Рецензирование
Main anatomic landmarks for prosthetic surgical reconstruction of the pelvic floor via vaginal access. / Shkarupa, Dmitry D.; Kubin, Nikita D.; Peshkov, Nikita O.; Pridvizhkina, Tatiana S.; Komyakov, Boris K.; Gadzhiev, Nariman Kazihanovich.
в: Akusherstvo i Ginekologiya (Russian Federation), № 3, 2016, стр. 71-75.Результаты исследований: Научные публикации в периодических изданиях › статья › Рецензирование
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TY - JOUR
T1 - Main anatomic landmarks for prosthetic surgical reconstruction of the pelvic floor via vaginal access
AU - Shkarupa, Dmitry D.
AU - Kubin, Nikita D.
AU - Peshkov, Nikita O.
AU - Pridvizhkina, Tatiana S.
AU - Komyakov, Boris K.
AU - Gadzhiev, Nariman Kazihanovich
N1 - Publisher Copyright: © Bionika Media Ltd.
PY - 2016
Y1 - 2016
N2 - Prosthetic reconstruction of the pelvic floor via vaginal access is a common and effective approach to treating the obvious forms of pelvic organ prolapse. The specificity of this technology is an abundance of blind steps when a surgeon has no direct visual control of manipulations – all is based on tactile sensations and spatial sense. Under these conditions, a thorough knowledge is a key condition for surgical safety. Objective. To identify main anatomic landmarks for safe implantation of mesh endoprostheses via vaginal access, by applying harpoon fixators, and to determine the optimal sizes of endoprostheses to achieve the necessary result in most patients. Subjects and methods. A total of 120 women underwent radiographic examination (pelvic bone X-ray, small pelvis computed tomography (CT), and small pelvis CT angiography. The examination revealed no statistically significant correlation between the patients’ anthropometric measurements (height, weight) and the distance between the obturator foramens and ischial spines. Results. These distances were found to vary minimally. The interspinous distance was 108.03±5.91 mm (range, 96.14—124.04 mm); the interobturator foramina distance was 61.09±4.71 mm (range, 49.20 —71.67 mm). Examination of angiographic images showed that on sacrospinal fixation of a prosthesis, the points of injection should be offset by at least 1.5—2.5 cm from the ischial spine and be strictly within the sacrospinous ligament in order to prevent damage to vascular structures. The safe zone in the obturator foramen is in its inferomedial corner. Conclusion. The findings could determine the optimal size of an endoprosthesis. Thus, for the prevention of obstruction of the rectum and the neck of the urinary bladder on troacar-free application of meshes, the optimal length of the interspinous and interobturator parts of implantation should be 15 and 10 cm, respectively.
AB - Prosthetic reconstruction of the pelvic floor via vaginal access is a common and effective approach to treating the obvious forms of pelvic organ prolapse. The specificity of this technology is an abundance of blind steps when a surgeon has no direct visual control of manipulations – all is based on tactile sensations and spatial sense. Under these conditions, a thorough knowledge is a key condition for surgical safety. Objective. To identify main anatomic landmarks for safe implantation of mesh endoprostheses via vaginal access, by applying harpoon fixators, and to determine the optimal sizes of endoprostheses to achieve the necessary result in most patients. Subjects and methods. A total of 120 women underwent radiographic examination (pelvic bone X-ray, small pelvis computed tomography (CT), and small pelvis CT angiography. The examination revealed no statistically significant correlation between the patients’ anthropometric measurements (height, weight) and the distance between the obturator foramens and ischial spines. Results. These distances were found to vary minimally. The interspinous distance was 108.03±5.91 mm (range, 96.14—124.04 mm); the interobturator foramina distance was 61.09±4.71 mm (range, 49.20 —71.67 mm). Examination of angiographic images showed that on sacrospinal fixation of a prosthesis, the points of injection should be offset by at least 1.5—2.5 cm from the ischial spine and be strictly within the sacrospinous ligament in order to prevent damage to vascular structures. The safe zone in the obturator foramen is in its inferomedial corner. Conclusion. The findings could determine the optimal size of an endoprosthesis. Thus, for the prevention of obstruction of the rectum and the neck of the urinary bladder on troacar-free application of meshes, the optimal length of the interspinous and interobturator parts of implantation should be 15 and 10 cm, respectively.
KW - Interobturator distance
KW - Interspinous distance
KW - Pelvic organ prolapse
KW - Pelvic vessels
KW - Synthetic endoprosthesis
UR - http://www.scopus.com/inward/record.url?scp=84994895340&partnerID=8YFLogxK
U2 - 10.18565/aig.2016.3.71-75
DO - 10.18565/aig.2016.3.71-75
M3 - Article
AN - SCOPUS:84994895340
SP - 71
EP - 75
JO - АКУШЕРСТВО И ГИНЕКОЛОГИЯ
JF - АКУШЕРСТВО И ГИНЕКОЛОГИЯ
SN - 0300-9092
IS - 3
ER -
ID: 88138781