Y Hgc TP. Ho Chi Minh * Tap 21 * So 6 * 2017 N g h i e n cihi Y hpc
PHAU THUAT NOI SOI HCTTRO. ROBOT CCTDINH AM DA.O VAX) MOM NHO - N H T J N G KINH NGHIEM BAN DAXT
CUA BENH VIEN BINH DAN
Nguyin Vdn An*, Trdn Vinh Hung*, Phapi Hiiu Dodn*, Ngd Bai Hal*, Jennifer MB Josi**
TOMTAT
Mufi tieu: Nham ddnh gid nhung kit qudban dau cim phau thudt ndi soi ho trg bdng robot (goi tat IdPTNS robot) CO dinh &m dao vdo mom nhd de dieii tri_ sa sinh due nang dphu nutai BVBinh Dan
Berth nhdn & phuang phap: Tieu chudn chgn binh Id cdc tnecmg hcrp sa sinh due niedd3-4 hoac do2 co trieu chieng ldm dnh hudng chat lucmg song. Loai mdy robot duac diing IdDaVind thehe Si. Tong cdng 5 trocars duac su'dung dethuc hien noi soi obung, gain 4 trocars cua mdy robot DaVind vdi trocar cua PTNS tiiu chuan ddnh cho ngum phu mo. Phuang phdp mo Idphau thudt co dinh am dap vdo mdm nhd tieu chudn.
Ket quid 3 phu nie turn 55,59 vd 65, deu hi sa sinh due rmng cd triiu doing, daduoc thuc him PTNS robot CO dmh am dap vwj mom nhd. 2 truang hop la sati/cung, tru&ng hap cdn lid la sa mem cut am dap. BMI lan lugt Id 24,2; 31 vd33. Trong 2 trucmg hgp sa tie cung, 1 dugc cdt tie cung tren co tu cung trong luc mS. Chung tdi dung loai mesh PVDF (Dynamesl^, Reliv, Germany) cho 2 binh nh&n vd mesh polypropylene (Surgimesh®, Aspides, France) cho truang hgp cdn lai. Cd 3 trucmg hap diu dugc thiec hihi thdnh cdng. ThcA gian mo lan luot Id 275,240 vd 180 phut Khdng co tai bim trong mo. Luang mdu mat trong m8 it -50-100 ml Hdu phdu dim tien t^ ZM cd 3 truong hap xuat vien sau3-5 ngdy. Theo ddi sau md 3 thdng: cd 3 truang hap dm hit bisa sinh due, vet m8 lanh tdi khdng bi nhiem trung. 1 truang hop than dau vung day chdu, phdi dim tri_ khdng viim vd gidm dau 2 tudn. 1 tnecmg hap bi tieu khdng Idem sodt gang siec, phdi phau thudt TOT sau 2 thdng.
Kit ludm Nhung ket qud ban ddu cho thay PTNS robot co'dinh &m dao zmo mom nho la an todn vdhieu qua'.
Cdc biih chimg sau md'nhe vddeldidc phuc. Su phuc hoi gidi phau aia tinh trang sa sinh due rat tot Tuy nhiin, can theo dm l&u han va solugng bmh nhan nhieu hem decdket lum ddng muc.
Tiikhda: Sa tang ch&u; Robot; Co dinh dm dap vdo mem nhd SUMMARY
ROBOTIC-ASSISSTED LAPAROSCOPIC SACRAL COLPOPEXY - INTUAL RESULTS OF BINH DAN HOSPITAL
Nguyen Van An, Tran Vinh Hung, Pham Huu Doan, Ngo Dai Hai, Jennifer MB Jose'
* Y Hoc TP. Ho Chi Minh * Vol. 21 - No 6 - 2017:61 - 64 Objectives: To assess our initial results cf Robotic-assisted Laparoscopic Sacrocolpapexy (RLSC) for treatmmt of severe pelvic organ prolapse (POP) at Binh Dan hospital, Viet Nam.
Materials & Methods: Women zoith grade 3A genitourinary prolapse or symptomatic grade 2 of ihe ICS classification were chosm. A da Vina Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration (4 robotic trocars) and 1 conventional laparoscopic 10mm trocar were used. Standard techniques of sacral colpopexy were performed.
Results: 3 womm, 55, 59 and 65 years old, suffered from severe POP were consmtedfor RLSC. 2 patimts were uterus prolapse; the last one was vaginal vault prolapse. BMI were 24.2, 31 and 33. Of the 2 patients with
* BV Bfnh Dan, TPHCM, Viet Nam ** St Luke hospital. Gold city, Philippines Tdc gid bin lac: PGS. TS. Nguyen Van An DT: 0908163284 Email: [email protected]
Nghien ciru Y hpc Y Hgc TP. Ho Chi Minh * Tap 21 * So 6 * 2017
uterus prolapse, 1 zoos peiprmed supracervical hysterectomy befijre doing sacral colpopexy. We used mesh PVDF (DyrmmesMi, Reliv, (Germany) for 2 patimts and mesh polypropylme (Surgimesh®, Aspides, France) pr the last
The operation time zoas 275, 240 and 180 minutes. The operative blood loss was ~ 50-100 ml. The time of hospital stay zoas 3-5 days. No intra-aperative complication was recognized. Not any case had to convert to open surgery. The mean follaw-up time was 3 months: dl of three cases have very good anatomic outcome with stage 0 of POP-Q system. About post-operative complications: 1 patimt complained regional pain at posterior wall of vagina, which was treated by analgesics during 2 weeks, 1 patimt suffered from de novo stress urinary incontinence, which was resolved by TOT procedure after 2 month.
Conclusiom Our early results show that RLSC is safe and ^cacious, the complications are minor and the anatomical outcomes are satisfactory. Howeoer, long-term folloio-up are needed.
Key words: Pelmc organs prolapse; Rdiot; Sacrocolpapexy
DAT VAN DE nhimg kinh nghiem ban daiii thu thap dccac ciia nhimg truong hop neu tren.
Phaii thuat eo dinh am dao vao mom nho (sacrocolpapexy) tu lau da"la'phucmg phap dieu tri, dveac chap nhan de dieu tri sa tang chau nu, do tf Ie thanh cong ve mat gia phaii cao so vofi cac phuang phap phau thuat qua nga* am dap {78 - 100%)'**. Tuy nhien do day la" mo ngo' nga' bung nen seo mo dai va" thoi gian hoi phuc keo dai, nen ke lu giira thap nien 1990 xuat him nhieu bao cab ve phaii thuat noi soi o bung eo dinh am dap vao mom nho (laparoscopic sacrocolpapexy)'-*^.
So sanh vcfi phau thuat ngd^ phau thuat noi soi co'hieu c|ua' dieu tri tuong duong nhung co' seo mo nhd^ it chay mau trong khi mcf, it dau sau mo va" then gian phuc hoi nhanh hon. Theo da" phai trien cua phaii thuat ft xam hai, tugiifa thap nien 2000 bat daiii co' nhimg bao cab cua phaii thuat noi soi ho" trq bang robot eo dinh am dap vao mom nho (rc^otic-assissted laparoscopic sacrocolpopexy)'^\
O Viet Nam, PTNS eo dinh am dap vao mom nho da" duoc bao eao tu hon 10 nam qua, va" da"
eo' mpt so bao cab duoc ghi nhan o' cac trung tam Ion co' chuyen khoa Nieu va' Phu SMI^'^'^. Cuoi nam 2016 ghi nhan mpt buoc tian men cua ngoai khoa Viet Nam khi BV Bihh Dan duoc trang bi mot thiet bi robot ho" trp cho phaii thuat npi soi.
Chimg toi da" thuc hien thmh cong nhimg truohg hpp daii tien co dinh am dap vao mom nho vca PTNS robot, trong do 1 dupe hcTtro tu chuyen gia ntroc ngoai. Bai viet nay trinh bay
TlJlIEUVAPHl/ClNGPHAPNGHIIENCUtJ Chi dmh mo: bi sa sinh due muc do nang (do 3, 4) ho|c muc dp trung bfrih (dp 2) nhimg co trieu chimg Iam anh huong chat luong song cua b&ihnhan.
Tieu ehuah loai trii bao gom nhung trucmg hpp benh ly ac tinh hoac dang viem nhiem cap tinh ciia cac co quan day chau, b&ih ly di kem hoac the trang benh nhan khong cho phep ti&i hanh cupc mo keo dai tr&i 2 gia vcfi bom hoi trong o bung va'nam dau tiiap.
Loai may robot duoc dung la DaVind the he Si.
Phau thuat noi soi 6 bung dupe Hen hanh vd 5 trocars, trong do co' 4 trocars ciia may DaVind (1 trocar 12mm eho camera va 3 trocars 8mm cho ca'e dung cu_ phau thuat Maryland bipolar, scissor monopolar va prograsp) va 1 trocar 10mm aia dung cu PTNS tieu chuan danh cho ngucri phu mo de t i ^ te gac, kim chi va' manh ghep va'de su dmig dung cuhiit dich.
Loai mesh dupe dung la' vat lieu PVDF aia eong ty Reliv (Djmamesh®) hoac polypropylene cua cong ty Aspides (Surgimesh®).
K E T Q U A '
3 phu nu'tuca 55, 59 va" 65 da" dupe chung toi thuc hi&i PTNS robot co dinh am dao vab mc)in
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Y Hgc TP. Hb Chi M i n h * Tap 21 * So 6 * 2017 Nghien cmi Y hgc
nho trong thaihg 12/2016, deu duqc chah doan sa tang chau co tri&u chimg.
BMI lah lupt Ia"24,2; 31 va 33.
Kham lam s ^ g kei hop MRI ghi nhan mtfc do sa tang chau
Truang hgp 1: sa bang quang va sa ti^ cung dp 3, tui sa true trang dp 1;
Truong hop 2: sa bang quang dp 3, sa mom cut am dap dp 4, ttii sa true traihg dp 2;
Truong hpp sau cung: sa b m g quang va sa tli cung do 2 nhung gay nang tut kho chiu va' roi loan tieii.
Ti&i si^ san phu khoa
1 trucmg hpp da dupe cat tu cung truc/e do' va" sau do' bi sa mdm cut am dao, 2 truong hpp con lai chua cat tu cung. Ca 3 truong hcyp deu da"
sinh eon nga' tu nhien tu" 2 - 4 lah.
Tat ea 3 b&ih nhan deu co' trieu chiAig nang tiic vung chau, tieu kho' khi khoi sa nhieii va' khong co' trudng hop nao bi tab boh.
Chon manh ghep va" each khau vao Qiarih am dao
Chuhg toi su^ dung manh ghep Dynamesh®
hinh ehifY cho b m h nhan bi sa mom cut am dao va"cho banh nhan dupe eat tu cung trong luc mo.
Vca truohg hop sa tif cung ma" khong cat td eung , chuhg toi cat 2 manh ghqj Surgimesh: manh trude hihh chu L ngupe khau vdi thanh trudc am dao, manh sau hihh chif T khau vol thanh Bang 1- Muc do cdi thim sa tang chdu sau mo 3 thdng
sau am dap. Manh ghep phia trudc khau vcn ihahh trudc am dao sau tdi gah tam gjac bang quang. Manh ghep sau khau sau xumig thanh sau am dao hoac khau toi eo day chau 2 ben neu CO tui sa true trang. Cac mm khau va'o thanh am dao dung chf prolene 2.0. Duoi cua ca'c msmh ghep se" khau va'o day chang doc song d mdm nho xuong cung bang 2 mm chi prolene 1.0.
Then gjan mo lah luot la' 275, 240 and 180 phut.
Khong CO tai bi&i trong mo. Khong eo' trucmg hc^ na"o chuy&i mo ngd.
Luang mail mat trong mo rat it, khomg 20 - 30 ml.
DiSi tien sau mo tdt cho ca 3 trucmg hop.
Thong tieu duac nit ngay hau phaii thu 3. Xuat vien sau mo 4 - 5 ngay. Cac b/n dupe eat chf tai y te dia phuang.
Tai kham sau mo' 1 thang va" 3 ihang Ca' 3 truong hop deu dupe dscrih gia' la' thanh cong ve muc do sa tang chau. Ngoai ra, vet md lanh tdt khong bi nhiSn triing va' vung da'y chau khong bi dau.
Ve bieh chimg sau mo'
1 truong hop tiian dau vung da'y chau, phau dieu tri, khang viem va" giahi dau 2 tuah. 1 truong hcyp bi tieu khong idem soa't gang sue, dieu tri_noi khong hieu qua'nen phai phau tiiuat TOT thihe'tSOTi tieh.
Ngo Till H 55t Ngo Tiij T.59t LamThjT.est
Tfuo^mS Sau mo 3m
TixTOcmo Sau md 3m
Tnfffc mo Sau mo 3m
Sa khoang tnpoc (bang quang) 2 0 3 1 3 1
Sa khoang giiia Ti>cung
2 0
4
Mom c^it AD
3 0 0
Sa khoang sau (tui sa fryc trang) 1 0 2 1 1 0 BATV LUAN
Ve hieu qua' ciiia p h » i thuah
- Ca' 3 truong hop deii duoc thuc him thanh cong, khong de xa'y ra tai bien trong khi md hoac
bien chimg sau md. Khong cd trudng hop nab phai chuym mdngd.
- Muc do c £ thien gim phaii cu'a sa tang chau la' ra't tdt sau 3 thang. Chua ed trucmg hop na'o bi tai phat tinh trang sa.
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Nghien cuu Y hpc Y Hgc TP. Hlo Chi Minh * Tap 21 * So 6 * 2017
- Cd 1 trudng hop sau khi het sa tang chau ihi phat sinh tieu khong ki&n soat khi gang sue, phai Iam tiiem phaii tiiuat TOT thi het son tieu.
- Chua ghi nhan cac bien chimg khac nhu nhiSn tnmg, dau vung chau, 16 mesh...
Nhimg thuan lm aia PTNS robot trong phaii thuat co dmh Sun dap vao mom nho
- So vdi PTNS tmyen thong, PTNS robot giup eho kha' nang quan sat ro" rang hon vi do phong dai eao hon (cd the gap 12 lan), hihh Etnh 3 D, phau thuat vien tu chinh nel de" dang trong lu'c md.
- Kha nang xoay tdi 540 do cu'a dung cu phau thuat giup tao tae rat linh hoat va thuan tien.
Viec khau nra trong PTNS robot trd nen de dang hon nhieii so vcn PTNS kinh dim.
- Kha nang tu giif cu'a dung cu_ (ciiuhg tdi thudng diing cdnh tay sd 3) co the giup ven ruot, nang tu^ cung rat huu ich cho cudc mo.
- Phlu thuat vim it met hem so voi PTNS kinh dim, vi thuc hien d vi trf ngoi, khdng van dung nhieii sue lue khi thao tat.
Nhung d i ^ han die cah luu y
- Chon vi tri dat trocars va' hudng eua ca'e canh tay robot so vdi ngudi b m h la" het siic quan trraig. Chung toi cho rang miic dp quan trpng ciia dieu nay trong PTNS robot la" hem nhieu so vdi PTNS noi soi kinh dim, vi neu udc luong khdng phii h c ^ thi se rat khd khan trong cupc md, va' viec ap dat lai ca'e eahh tay robot (docking) lai la mat thai gian va kha'phiic tap.
- So vdi PTNS kinh d i m thi viee dinh vi mdm nhd kho hem, vi phau thuat vien khong CO cam giac sd cham len phan nhd len va cung qua canh tay robot. De khac phuc dieu nay, chung tdi phai nhd den cam gia'e cu'a ngudi phu mo^ dung dung cu. cu'a PTNS kinh dien de dinh vi giup mom nhd.
- Cling do ban die ve cain gia'e, viec cam nam mo khi thao ta'c cuhg nhu cam nam chf khi khau cot de'bi qua'mirc, lam dap na't md hoac dii
khau. Da sd ea'c phaii thuat vien se" khac phuc duoc van de nay sau khi thuc hien PTNS robot nhimg truong hpp dau tien.
KET LUAN
PTNS hd tro bang robot co dinh am dao vab mdm nhd de' dieii tri_ sa sinh due ed the thuc hioi ihanh eong, an toan va'hieu qua trong dieii kien Viet Nam.
Thdi gian mo con ke'o dai chua thSy rd uu diem so vdi PTNS kinh dim, tuy nhien day la nhiing trudng hpp dau tien do chung tdi con chua quen vdi viec dieii khim robot.
So trucmg hop con it, thc« gjan theo dcH chua dai, nen diiing tdi can tiep tuc bd sung ve so lupng eiing nhu then gian de eo nhimg nhaa dinh dung d m hon ve loai phaii thuat nay.
TAI LIEU THAM KHAO
1 Di Marco DS, Chow GK, C;ettman MT, Elliott DS (2004).
Robolioassisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology 63 (2): 373-376 2 D 5 Nguyen Phirong. T ^ n Quang Phuc, Nguyin Thj Nga,
Chau Qiiy Thu|ii, Tran Trgng Tri, Tran Ngpc Sinh (2010) P h l u thu$t n$i soi o byng gSy tSn thirong nang he det n i ^ . Tap chi Yhoc Viet Nam375:55i6S7.
3 NBM Nhi, FT Nga, VP ThSng & cs (2011). Danh gia buoc 3Sax h i ^ qua va d p an toan cua phau thu§ttieotu'cung vao mom n h 6 qua n$i soi S bung trong digu tri sati^ cung t^ib^nh w t Tit Du. Tgp dii Y hoc TPHCM. 14(2): 89-95.
4 Nezhat CH, Nezhat F, Nezhat C (1994). Laparoscopic sacral colpopexy ka vaginal vault prolapse. Obstet (^neaA 84:685-8 7.
5 Nguyen Van An, V6 Tran Thirong Phong, Pham Huy Etoah b cs (2014), A p dung phEfti thuat nro s d treo am dao vab mdm nho de d i & t n s a sinh due nang. Tap dn'Yhx TpHCM, 18 (1):
424428.
6 Nygaard IE, McCreeiy R, Brubaker L, Connolly AM, Cundiff G, Weber AM, et al (2004) Abdominal sacrocolpopexy: a comprehensive review. (}bstet Gynecol 104:805-23.
7 Paraiso MF, Walters MD, Raddey ER, Melek S, Hugney C (2005). Laparoscopic and abdominal sacral colpopenes: a comparative cohort study, .^m / Obstet GyneaA 192-1752- 8.
8 TH Sinh, Renaud B, Fabienne A (2004). P h l u t h u | t n§i s a S byng trong digu t i sa sinh d y e nhan tiuimg h ^ p ^ u tien t?) BV Chgt Riy. Top difV tec TPHCM, 8(2) 208-211.
Ngay nhan bdi bdo: 10/06/2017 Ngdy phdn biin nhan xet bdi bdo: 18/06/2017 Ngdy bdi bdo dugc ddng: 30/10/2017
