Intraoperative Fluoroscopic Monitoring during TVM Surgery: Safer Procedure Even for Beginners

• 作者: Hideki Kobayashi Hidenori Zakoji Isao Araki Masayuki Takeda Norifumi Sawada Satoru Kira Takayuki Tsuchida Tatsuya Miyamoto Yaburu Haneda
• 来源期刊: 泌尿学期刊(英文)
• 学科: 医学
• 关键词: PELVIC Organ Prolapses SURGERY Tension Free VAGINAL Mesh Fluoroscopic Imaging MONITORING
• 年，卷（期）: 2012,（2）
• 页码范围: 72-74
• 页数: 3页
• 分类号: R73

摘要

Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.