System for treating SUI through transvaginal urethra middle section perpubic ligament linear suspension

Abstract

The invention belongs to the field of intelligent medical treatment, and particularly relates to a system for treating SUI through transvaginal urethra middle section parapubis ligament linear suspension. The system comprises: a positioning dissection treatment unit 101, which is used for longitudinally cutting the vagina anterior wall mucous membrane along the median line of the vagina anterior wall to a set depth under the urethral transverse sulcus; the separation and exposure treatment unit 102 is used for separating the bladder from the vaginal wall, then separating the left / right gap of the bladder to obtain free fascia beside the middle section of the left / right urethra, and exposing the left / right pubis descending lateral ligament; and the suspension treatment unit 103 is used for respectively lifting fascia beside the middle section of the left / right urethra to a left / right pubis descending lateral ligament obliquely above the urethra for suturing and fixing. The inverted splayed linear seam of the fascia tissue beside the middle section of the urethra is hung to the ligament beside the pubis, meanwhile, the sutures on the two sides do not intersect at the middle line of the urethra, the included angle between the urethra and the bladder is recovered from the anatomy of the autologous tissue, the risks of mesh erosion, exposure and the like are avoided, and postoperative urethra obstruction and urinary retention are reduced.

Description

Technical Field

[0001] The present invention relates to the field of intelligent medical treatment, and more specifically, to a system and device for treating SUI through a transvaginal mid-urethral parapubic ligament linear suspension technique. Background Art

[0002] Stress urinary incontinence (SUI), also known as tension urinary incontinence, is typically characterized by involuntary urine overflow due to increased abdominal pressure, often accompanied by urinary urgency and frequency, which seriously affects the patient's quality of life. SUI can be divided into mild, moderate, and severe categories based on the main clinical symptoms. Urinary incontinence that occurs when coughing or sneezing is considered mild, while leakage during daily activities such as running, jumping, and brisk walking is considered moderate; and urinary incontinence that occurs during minor activities or changes in supine position is considered severe. A 2021 epidemiological survey conducted by the American Urological Diseases Project on data from 15,003 women aged 20 and above from 2005 to 2016 showed that the prevalence of SUI in European countries is 23% to 44%, and the prevalence in the United States is approximately 42%. Baessler K et al. reported that the incidence of pelvic organ prolapse (POP) in women is as high as 60%. 55% of patients with stage 2 POP experience concurrent SUI, and 33% of patients with stage 4 POP experience SUI symptoms. During examinations, when prolapse is digitally reduced using a pillow or speculum, the prevalence of SUI can reach as high as 68%. With the aging population, the incidence of SUI is increasing, placing a significant burden on families and society. Furthermore, with the continuous development of society and the increasing demand for quality of life, SUI in women is receiving increasing attention. Epidemiological surveys have found that the incidence of SUI in Chinese women is 18.9%, with prevalence increasing with age. Overall, the prevalence in urban areas (16.4%) is lower than in rural areas (21.4%). Although the condition is not life-threatening, it can cause uncontrolled urine leakage, leading to negative emotions such as shame and low self-esteem, and severely harming psychological, mental, and social well-being. It has been called a "non-lethal social cancer."

[0003] Ballert et al. found that the incidence of urinary incontinence after surgical treatment of POP was 11%-22%, and it could even reach 36%-80% in patients with severe prolapse. In patients with severe POP, the anatomical position of the bladder and urethra is severely changed, leading to urethral obstruction and symptoms of dysuria, which mask some of the symptoms of combined urinary incontinence. Currently, there is controversy over whether to perform preventive treatment for urinary incontinence during surgical treatment of patients with severe POP. However, research by Cui Wei et al. shows that for POP patients who can be clearly diagnosed with IUS and OSUI before surgery, surgical treatment for urinary incontinence should be performed at the same time. Asklin B, Zhu Lan et al. also showed that patients with pelvic organ prolapse accompanied by SUI who need pelvic floor surgery can also undergo anti-SUI surgery at the same time.

[0004] Currently, there are diverse but not unified methods for treating SUI, which can be generally categorized into conservative and surgical treatments. Non-surgical treatments are suitable for mild cases and include lifestyle interventions, pelvic floor muscle training, pelvic floor electrical stimulation, medication, and uterine prolapse. Patients with moderate to severe SUI require surgical treatment. Surgery is the primary and most effective treatment for moderate to severe SUI. The goal is to alter the pelvic floor anatomy, increase urinary control at the bladder neck and urethra, and combat urinary incontinence. Currently, the surgical methods commonly used in clinical practice include: Burch sling, tension-free vaginal tape (TVT), outside-intransobturator tape (TOT), inside-out tension-free vaginal tape-obturator (TVT-O), tension-free vaginal tape (TVT-S), and single-incision adjustable sling (Ajust). Although the above-mentioned SUI treatment methods have achieved certain results, there is still no unified surgical treatment plan for SUI.

[0005] The main causes of SUI are decreased pelvic floor support due to pelvic floor muscle damage, damage to surrounding tissues supporting the urethra, and pathology of the urethral sphincter itself. Currently, the "hammock" technique is widely used in clinical practice. TVT and TVT-O are commonly used surgical procedures due to their minimal trauma, high cure rates, and shorter operative times. However, TVT can easily damage the bladder during surgery, requiring cystoscopy to rule out bladder injury. TVT-O also has a high incidence of postoperative groin pain and is expensive. New slings still require ongoing multicenter, large-sample, randomized controlled trials and evidence-based research to identify safe and effective individualized treatments and minimize surgical complications. Zhou Li et al. published "Use of Urethral Plexis Combined with Midurethral Pubic Suspension in the Treatment of Stress Urinary Incontinence" ("Urthroplasty Combined with Midurethral Interruption and Pubic Suspension"), which describes a hammock-free, transurethral plexithion combined with urethral interruption and pubic suspension. After urethral plexithion, the posterior urethral ligament is sutured with a mattress suture to support the urethra. Non-absorbable sutures are then used to suture the periosteum of the inferior pubic margin near the pubic symphysis on one side, and the periosteum is then sutured to the midurethral tissue. After the suspension is completed, absorbable sutures are used to suture the vaginal mucosa. However, this procedure, which combines transvaginal urethral plexithion with urethral interruption and pubic suspension, is cumbersome and carries a high risk of intraoperative trauma, making it difficult to promote at the grassroots level. Furthermore, the surgical approach described in this article was designed for patients without POP, and its efficacy in patients with SUI and POP is unknown. Therefore, a simple and effective mesh-free surgical system for mid-urethral linear suspension of the vaginal parapubic ligament is urgently needed, especially in grassroots settings, to treat women with POP and SUI. Summary of the Invention

[0006] In view of the above problems, the present invention provides a system for treating SUI through a transvaginal mid-urethral parapubic ligament linear suspension technique, which utilizes the mid-urethral vagina to suspend the parapubic ligament to achieve the treatment of SUI combined with POP.

[0007] The present application (first aspect) discloses a system for treating SUI by transvaginal mid-urethral parapubic ligament linear suspension, comprising: Positioning and dissection processing unit 101: used to longitudinally incise the anterior vaginal wall mucosa along the midline of the anterior vaginal wall to a set depth below the transverse urethral groove, and separate the bladder from the vaginal wall; Separation and exposure processing unit 102: used to locate the left and right spaces of the bladder, separate the left and right spaces of the bladder, and expose the left / right mid-urethral fascia and the left / right lateral ligament of the descending pubic branch; The suspension processing unit 103 is used to respectively pull up the parafascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

[0008] Furthermore, the suturing and fixing in the urethral interruption suspension processing unit 103 is an inverted "eight" suturing, specifically: the fascia beside the left / right mid-urethra is pulled up to the left / right lateral ligament of the descending pubic branch obliquely above the urethra, so that the pulled fascia on the left and right sides form an inverted "eight" shape and then sutured and fixed; Optionally, the stitches for suturing and fixing on both sides do not cross at the midline of the urethra, and are separated by a gap of a set width at the midline of the urethra.

[0009] Furthermore, the angle between the fascia and the urethra level after lifting is 10°~30°; Optionally, the angle between the fascia and the urethra level is 25° after lifting; Optionally, the fascia beside the left / right middle urethra is pulled up to the left / right lateral ligament of the descending pubic branch obliquely above the urethra in the direction of the human body cross section and sutured and fixed; optionally, No. 7 silk thread is used for the suture fixation.

[0010] Furthermore, the suture fixing lines in the suspension processing unit 103 do not cross at the urethral midline, and the fixing lines on both sides are separated by a gap of a set width at the urethral midline; Optionally, the set width is 0.3-1 cm; Optionally, the set width is 0.5 cm.

[0011] Furthermore, the set depth is 0.2~0.5cm; Optionally, the set depth is 0.3 cm.

[0012] Furthermore, the system further comprises a hemostatic suturing processing unit 104 for suturing the anterior vaginal wall mucosa along the midline of the anterior vaginal wall.

[0013] Furthermore, the suture hemostasis is specifically as follows: first, continuous suture is used for hemostasis, and excess vaginal wall tissue is trimmed after suturing; then, continuous locking suture is used for autologous tissue along the urethra for the second time.

[0014] In a second aspect, the present application discloses a device for treating SUI by performing a transvaginal mid-urethral parapubic ligament linear suspension procedure. The device comprises: a single or multiple processors, and a memory; the memory is used to store a single or multiple computer program instructions; when the single or multiple computer programs are executed by the single or multiple processors, the following steps are performed: S101: Locate the midline of the anterior vaginal wall and make a longitudinal incision along the midline of the anterior vaginal wall to the set distance below the transverse urethral groove to separate the bladder from the vaginal wall. S102: Separate the bladder and vaginal wall, then separate the left / right space of the bladder to obtain the free left / right mid-urethral fascia and expose the left / right lateral ligament of the descending pubic branch; S103: Pull the para-urethral fascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

[0015] Furthermore, when the single or multiple computer programs are executed by the single or multiple processors, the following steps are performed: S101: Locate the midline of the anterior vaginal wall and make a longitudinal incision along the midline of the anterior vaginal wall to the set distance below the transverse urethral groove; S102: Separate the bladder and vaginal wall, then separate the left / right space of the bladder to obtain the free left / right mid-urethral fascia and expose the left / right lateral ligament of the descending pubic branch; S103: The fascia of the left / right mid-urethra is lifted to the lateral ligament of the left / right descending pubic branch obliquely above the urethra, so that the lifted fascia on the left and right sides form an inverted "eight" shape and then sutured to fix. The suture stitches on both sides do not cross at the midline of the urethra, and a gap of a set width is separated at the midline of the urethra. S104: Suture the anterior vaginal wall mucosa along the midline of the anterior vaginal wall.

[0016] Furthermore, the device includes: a positioning member, a dissecting member, a separating member, and a suturing member; Optionally, the positioning dissection component includes: a microscope; The dissection tools include: tissue scissors, microscissors, stripping scissors, electric knife, No. 10 blade, fine-toothed forceps, mosquito curved forceps, curved hemostatic forceps, curved vascular forceps, The separating parts include: No. 10 knife handle, vaginal pressure plate The suture components include: No. 7 silk thread, gynecological suture needle, extracranial suture needle, needle holder, and 2-0 absorbable surgical suture.

[0017] This application has the following beneficial effects: (1) This application uses human tissue to achieve suspension without mesh, and there is no risk of mesh exposure or erosion; (2) This application fixes the paraurethral fascia to the descending pubic ligament by suturing it in an inverted “eight” linear manner, elevating the urethra and helping with urinary control. The surgical path is short and the risks of bladder injury, nerve injury, postoperative pain, and complications are low. (3) The inverted "eight" linear sutures of this application do not cross at the midline of the urethra, which can effectively avoid the occurrence of urethral obstruction. The autologous tissue reinforcement of the midline of the urethra uses the body's own tissue for repair, which has a good postoperative recovery effect and a low risk of postoperative sequelae; (4) The suture reinforcement method of the present application avoids excessive trimming of vaginal tissue, which may lead to vaginal stenosis of the patient after surgery and affect sexual life; and the bleeding is completely stopped by bilateral suture. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] In order to more clearly illustrate the technical solutions in the embodiments of the present invention, the following briefly introduces the drawings required for use in the description of the embodiments. Obviously, the drawings described below are only some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without creative work.

[0019] Figure 1 A schematic diagram of a system flow chart is provided in accordance with a first aspect of an embodiment of the present invention; Figure 2 This is a schematic diagram of a conventional mid-urethral pubic suspension procedure provided by an embodiment of the present invention, in which a "hammock" is formed by simulating a mesh and fixed to the periosteum of the inferior pubic edge near the pubic symphysis; Figure 3 This is a schematic diagram of the suturing position of a suspension processing unit provided by an embodiment of the present invention; Figure 4 1 is a schematic diagram of a treatment process for post-positional dissection and separation exposure provided by an embodiment of the present invention; Figure 5 is a schematic diagram of a processing process of separating and exposing a processing unit provided by an embodiment of the present invention; Figure 6 It is a schematic diagram of suspension processing of a suspension processing unit provided by an embodiment of the present invention. DETAILED DESCRIPTION

[0020] In order to enable those skilled in the art to better understand the solutions of the present invention, the technical solutions in the embodiments of the present invention will be clearly and completely described below in conjunction with the accompanying drawings in the embodiments of the present invention.

[0021] In some of the processes described in the specification and claims of the present invention and the above-mentioned figures, multiple operations that appear in a specific order are included, but it should be clearly understood that these operations may not be executed in the order in which they appear in this article or may be executed in parallel. The serial numbers of the operations, such as S101, S102, etc., are only used to distinguish between different operations, and the serial numbers themselves do not represent any execution order. In addition, these processes may include more or fewer operations, and these operations may be executed in sequence or in parallel. It should be noted that the descriptions of "first", "second", etc. in this article are used to distinguish different messages, devices, modules, etc., and do not represent the order of precedence, nor do they limit "first" and "second" to be different types.

[0022] The following will clearly and completely describe the technical solutions in the embodiments of the present invention in conjunction with the accompanying drawings. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without making any creative efforts shall fall within the scope of protection of the present invention.

[0023] Figure 1 1 is a flow chart of a system for evaluating transvaginal midurethral parapubic ligament linear suspension for the treatment of SUI, provided by an embodiment of the present invention. Specifically, the system includes: Positioning and dissection processing unit 101: used to longitudinally incise the anterior vaginal wall mucosa along the midline of the anterior vaginal wall to a set depth below the transverse urethral groove.

[0024] In some embodiments, the preliminary steps of the operation are consistent with the prior art. After the target area is surgically incised, the anterior vaginal wall mucosa is longitudinally incised along the midline of the anterior vaginal wall, and the cutting is stopped after reaching a certain depth below the transverse urethral groove.

[0025] In some embodiments, the system is also equipped with an intraoperative recognition system that can accurately identify the midline of the anterior vaginal wall based on the results of computer vision. The system's projection system will identify the midline of the anterior vaginal wall and then project the midline to guide the system's scalpel to cut the anterior vaginal wall mucosa and stop cutting after reaching the set depth below the transverse urethral groove.

[0026] In some embodiments, the system makes a longitudinal incision about 4 to 6 cm long along the middle of the anterior vaginal wall, starting from the inferior urethral groove and 0.5 cm above the bladder groove. The depth of the anterior vaginal wall is cut to the lower layer of the vaginal mucosa, separating the vagina and the bladder. Care is taken to preserve the fascia tissue on the bladder wall as much as possible, about 0.2 to 0.3 cm ( Figure 4 shown).

[0027] Separation exposure processing unit 102: used to separate the bladder and vaginal wall, separate the left and right spaces of the bladder, and free the left / right mid-urethra parafascia and the left / right lateral ligament of the descending pubic branch.

[0028] In some embodiments, the system's robotic arm will locate the cut edge of the anatomical processing unit and lift it with tissue forceps, free the vaginal wall to both sides along this plane, expose the bladder neck, preserve the posterior urethral ligament around the urethra as much as possible, free the paraurethral tissue above both sides of the urethra, separate the bladder and vaginal wall, and then further separate the left side of the bladder space and the right side of the bladder space, freeing the left mid-urethral fascia, the right mid-urethral fascia, the left lateral ligament of the descending pubic branch, and the right lateral ligament of the descending pubic branch.

[0029] In some embodiments, the left side of the bladder is separated by lifting the incision edge of the vaginal wall with a tissue forceps, and separating the fascial tissue between the vaginal submucosal layer and the bladder and urethra with the handle of the knife outward, freeing the vaginal mucosal wall to expose the left descending pubic branch, bladder neck and mid-urethra (such as Figure 5 shown).

[0030] The suspension processing unit 103 is used to respectively pull up the parafascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

[0031] In some embodiments, the surgical robot of the suspension processing unit of the system pulls the left side of the urethra to the left side of the lateral ligament of the descending pubic branch above the urethra and sutures it, and pulls the right side of the urethra to the right side of the lateral ligament of the descending pubic branch above the urethra and sutures it. The above side is a cross-section of the patient in a supine position, on the lateral ligament of the descending pubic branch above the horizontal line of the urethra, so that the pulling direction of the fixed left side of the urethra and the pulling direction of the right side of the urethra form an inverted "eight" shape, as shown in FIG. Figure 3 shown.

[0032] In some embodiments, the purpose of raising the urethra is achieved by an inverted "eight" suture, wherein the extent of the elevation is related to the fixed position on the lateral ligament of the descending pubic branch, and in the cross-sectional direction of the human body, the angle between the inverted "eight" suture line and the horizontal line of the urethra is greater than 0° and less than 45°.

[0033] In some embodiments, the computer recognition module of the system can accurately locate the lateral ligament of the descending pubic branch located obliquely above the urethra based on the patient's urethra position, and guide the suturing and fixation operation of the surgical robot based on the results of computer recognition.

[0034] In some embodiments, the system further comprises a hemostatic suturing processing unit 104 for suturing the anterior vaginal wall mucosa along the midline of the anterior vaginal wall.

[0035] In some embodiments, after the mid-urethra is elevated, a modified suture is performed on the midline of the anterior vaginal wall: the first continuous suture is performed to trim excess vaginal wall tissue; the second continuous locking suture is performed to reinforce the autologous tissue along the urethra.

[0036] In some embodiments, when suturing the midline of the anterior vaginal wall, a first round of continuous horizontal mattress sutures is performed. After the first round of suturing is completed, a vaginal retractor approximately 4.5 cm wide is inserted into the vagina to determine the tightness of the vagina. If it is too tight or too loose, the sutures can be removed and re-sutured. After adjusting the vagina to the appropriate tightness, the excess vaginal wall tissue is trimmed (the vaginal tightness can be elastically adjusted); then, after adjusting the vagina to the appropriate tightness, a second round of continuous locking sutures is performed to completely stop bleeding. The autologous tissue running along the urethra has the effect of reinforcing and elevating the mid-section of the urethra.

[0037] In some embodiments, the system uses a simulated suturing device to simulate the effect of the first round of continuous horizontal mattress suturing and then determines the tightness of the vagina. If the tightness of the vagina is within the set range, the actual suturing operation is performed according to the settings of the simulated suturing, and the second round of suturing is performed after the excess vaginal wall tissue is removed, thereby achieving an improved midline suture of the anterior vaginal wall.

[0038] In some embodiments, the system's simulated suturing device adaptively adjusts the tightness of the vagina to a set range to obtain a simulated sewing line. The vaginal surgical robot performs the first suturing according to the adjusted simulated sewing line, and then performs the second suturing after removing excess vaginal wall tissue.

[0039] In some embodiments, the system performs the following steps: Step 1: (1) From the position between the inferior urethral groove and 0.5 cm above the bladder groove, make a longitudinal incision of the anterior vaginal wall mucosa in the midline of the anterior vaginal wall, about 4 to 6 cm long. The depth of the incision should reach the lower layer of the vaginal mucosa and enter the vaginal vesical space, about 0.2 to 0.3 cm.

[0040] (2) Use tissue forceps to symmetrically lift the cutting edges of the vaginal wall on both sides, and use the knife handle to separate the fascial tissue between the vaginal submucosa and the bladder and urethra outward, freeing the vaginal mucosal wall to expose the left descending pubic branch, bladder neck and middle urethra, and retain the paraurethral fascia and bladder surface fascia tissue.

[0041] Specifically, it includes: (1) Use water to separate the bladder, urethra and vaginal space: inject 12 U of posterior pituitary hormone + 200 mL of normal saline solution, or 1:200,000 times diluted epinephrine saline into the bladder, urethra and vaginal space; (2) Place a balloon catheter to determine the location of the bladder neck.

[0042] (3) Make a longitudinal incision about 5 to 6 cm long along the middle of the anterior vaginal wall between the inferior urethral groove and the transverse vaginal groove. The depth of the incision should be about 0.3 to 0.5 cm, enough to expose the bladder neck and the muscle layer of the posterior urethral wall.

[0043] (4) Lift the incision edge with tissue forceps and free the vaginal wall to both sides along this plane to expose the bladder neck. Try to preserve the posterior urethral ligament around the urethra and free the paraurethral tissue above both sides of the urethra until the periosteum at the lower edge of the pubic symphysis is touched.

[0044] Step 2: Separate the left side of the bladder to expose the lateral ligament of the left descending pubic branch, and treat the contralateral side in the same way; In some embodiments, the specific steps performed by the system include: (5) separating and exposing the bladder neck: inserting a No. 16 catheter into the urethra, about 1 to 2 cm away from the junction of the bladder and urethra (i.e., the bladder neck), suturing both sides of the bladder neck with No. 7 silk sutures in a mattress-like manner, and raising the bladder neck after tying a knot. It should be noted that the tension should not be too high when tying the knot, and the No. 16 catheter should be pulled until it is slightly tightened to avoid tightening the urethra and causing postoperative urine retention.

[0045] (6) Mattress suture of the posterior urethral ligament: Use silk thread to make horizontal mattress sutures on both sides of the posterior urethra wall to support the urethra.

[0046] The advantages of this step are: the surgical path is shorter than TVT-O, it is easy to expose, it avoids the risk of damaging large blood vessels and nerves, and it is easy to promote in grassroots clinical settings.

[0047] Step 3: Use a 12×20 angle needle to pass through No. 7 silk thread to suture the lateral ligament of the left descending pubic branch. Change to a 6×10 round needle to pass through No. 7 silk thread and suture the left mid-urethra parafascia with one end. The distance between the needle insertion and exit points is about 1.5-2cm. Be careful not to suture too deep to avoid damaging the urethra and bladder. Tie a knot to fix the left mid-urethra parafascia to the left descending pubic branch lateral ligament in an inverted "eight" shape. Treat the opposite side in the same way, elevate the urethra and bladder neck, restore the angle between the urethra and bladder, and improve urinary incontinence. The sutures on both sides do not cross at the midline of the urethra, forming an inverted "eight" shape, which does not directly compress the urethra and avoids postoperative urinary tract obstruction and urinary retention ( Figure 6 shown).

[0048] like Figure 3 As shown, the fascia tissue of the middle section of the urethra is fixed to the parapubic ligament using No. 7 silk thread in an inverted "eight" shape. The sutures do not cross in the middle and do not directly compress the urethra, thus avoiding postoperative urinary tract obstruction and urinary retention.

[0049] Suture the periosteum at the inferior pubic margin near the pubic symphysis on one side with non-absorbable sutures. The periosteum is then sutured to the tissue surrounding the mid-urethra. The needle insertion and exit points are approximately 1 to 1.5 cm apart, parallel to the urethra and approximately 1 to 1.5 cm lateral to the urethra. After tying a knot, suspend the tissue surrounding the mid-urethra on the pubic periosteum. Suture the contralateral side in the same manner. After suspensory closure, suture the vaginal mucosa with absorbable sutures. Sterile gauze is placed inside the vagina to stop bleeding. An 18-gauge urinary catheter is then placed for urinary catheterization.

[0050] The advantages of this step are: (1) No. 7 silk thread is used to suture the fascia tissue in the middle of the urethra to the parapubic ligament in an inverted figure eight linear suture, replacing the mesh with autologous tissue, following the "hammock theory" to restore the angle between the urethra and the bladder anatomically, avoiding the risks of mesh erosion and exposure caused by mesh implantation; (2) The sutures on both sides do not cross at the midline of the urethra, thus avoiding the occurrence of urethral obstruction and urinary retention that may occur after surgery in TVT-O, TVT-A and other procedures.

[0051] Step 4: Perform a modified midline suture of the anterior vaginal wall: the first layer is a continuous suture, and excess vaginal wall tissue is trimmed; the second layer is a continuous locking suture, and the autologous tissue along the urethra has a reinforcing effect.

[0052] The advantages of this step are: bilateral suture of the anterior vaginal wall, complete hemostasis, reinforcement of the urethral midline with autologous tissue, and elastic adjustment.

[0053] Therefore, compared with the prior art (TVT-O), the beneficial effects achieved by this application mainly include: (1) The surgical path of step 2 is shorter than that of TVT-O, which is easier to expose and avoids the risk of damaging large blood vessels and nerves, and is easy to promote in the clinical grassroots.

[0054] (2) In step 4, ① the fascia tissue of the middle part of the urethra is sutured in an inverted figure eight linear manner with No. 7 silk thread to suspend it on the parapubic ligament, replacing the mesh with autologous tissue. Following the “hammock theory”, the angle between the urethra and the bladder is restored anatomically, avoiding the risks of mesh erosion and exposure caused by mesh implantation. ② The sutures on both sides do not cross at the midline of the urethra, thus avoiding the occurrence of urethral obstruction and urinary retention that may occur after surgery in TVT-O, TVT-A and other procedures.

[0055] (3) In step 3, the anterior vaginal wall is sutured on both sides to stop bleeding completely, and the urethral midline is reinforced with autologous tissue and can be adjusted elastically.

[0056] In some embodiments, the above steps are completed by a robotic arm carried by the system. At the same time, the system's camera system can accurately locate the bladder, vagina, parapubic ligament and other related tissues during surgery based on computer vision training.

[0057] In some embodiments, the above steps are performed by a surgical robot that is paired with the system. The system's electron microscope and other system-assisted imaging enable the computer vision-based recognition system to accurately identify and locate related tissues such as the bladder, vagina, and parapubic ligament during surgery.

[0058] Compared with the existing technology (mid-urethra pubic suspension), the improvements and beneficial effects achieved by this application mainly include: 1. The suspension site is different. In this application, the mid-urethra is suspended on the parapubic descending ligament. Compared with the prior art method of suspending the mid-urethra on the periosteum of the inferior pubic margin, the risk of bladder and urethra damage is high because the periosteum of the inferior pubic margin is relatively deep and close to the bladder. In contrast, the suspension site in this application is relatively shallow, with no large blood vessels and nerves around it and far away from the bladder, so the risk of damage to blood vessels, nerves, bladder, urethra, etc. is low. 2. The suturing method is different. In this application, the fascia tissue of the middle part of the urethra is fixed to the parapubic descending branch ligament by using No. 7 silk thread in an inverted "eight" shape. Figure 3 As shown), the sutures do not cross in the middle, and by reinforcing and elevating the fascia tissue beside the mid-urethra, the mid-urethra is elevated, urethral resistance is increased, and urination control is restored. The sutures are not directly sutured, and therefore, the mid-urethra is not compressed. In the prior art, a "hammock" is created under the urethra by simulating a mesh. If the tightness of the "hammock" is not properly controlled, it is easy to cause urethral obstruction and urinary retention after surgery. In comparison, the sutures in this application are not directly sutured, and therefore, the sutures do not compress the mid-urethra, which can restore physiological anatomy and avoid compression of the urethra that causes postoperative urethral obstruction and urinary retention. The risk of postoperative urethral obstruction and urinary retention is low. 3. Different methods of vaginal wall suturing: This application adopts a modified suture of vaginal wall tissue (first horizontal mattress suture of the vaginal wall for the first time, and then trimming the vaginal wall tissue): Among them, the first continuous horizontal mattress suture is performed. After the first suture is completed, the tightness of the vagina is judged (a vaginal retractor with a width of about 4.5 cm is inserted into the vagina). If it is too tight or too loose, the sutures can be removed and re-sutured. After adjusting the vagina to the appropriate tightness, the excess vaginal wall tissue can be trimmed (the vaginal tightness can be flexibly adjusted); then the vagina is adjusted to the appropriate tightness and a second continuous locking suture is performed to stop bleeding completely. The autologous tissue running along the urethra has the effect of reinforcing and elevating the middle part of the urethra.

[0059] The conventional method is to trim the vaginal wall tissue first and then perform continuous sutures. If the vaginal wall tissue is trimmed too much due to lack of experience or incorrect assessment, it may lead to vaginal tightness and vaginal stenosis after surgery, affecting the patient's sexual life.

[0060] The improved bilateral vaginal wall suture method described in this application involves a first horizontal mattress suture followed by trimming of the vaginal wall tissue. This allows for flexible adjustment of vaginal tightness, preventing excessive trimming of vaginal tissue that could lead to vaginal stenosis and affect sexual function. The two sutures provide thorough hemostasis, reinforce the urethral midline with autologous tissue, elevate the urethra, and improve urinary control.

[0061] In this application, a urinary catheter is left in place for 48-72 hours after surgery, and the urinary control rate after catheter removal can reach 95%. In the existing technology, a urinary catheter is left in place for 72-120 hours after surgery, and the effective urinary control rate after catheter removal is 90%. In this application, the postoperative urinary catheter retention time is shorter and the urinary control effectiveness is high.

[0062] In addition, the system and device of the present application are easy for primary medical personnel in remote areas and mountainous areas to master and promote. The surgical path is relatively short, there are no large blood vessels or nerves in the surgical area, the surgical complications are low, and it is easy to master and promote it to primary hospitals in remote areas and mountainous areas.

[0063] Data support: Retrospective analysis: Follow-up of 80 patients (17 patients lost to follow-up) who underwent transvaginal mid-urethral parapubic ligament linear suspension in our department from January 1, 2018 to December 31, 2022 due to POP combined with SUI: Postoperative treatment effect of urinary incontinence: 60 cases, 95% were cured, 3 cases, 3% improved; Urinary retention (catheter removed within 48 hours): 1 case of urinary retention, recovered after 1 week of catheterization, 1%; Intraoperative bleeding volume: 10-50 ml, rebleeding and hematoma occurred after surgery: 0 cases; Postoperative pain: 0 cases; Postoperative improvement of sexual life: increased satisfaction: 20 cases, 25%, satisfaction was the same as before surgery: 28 cases, 35%, no sexual life after surgery: 15 cases, 18%; Complications: None of the 63 patients who were followed up had complications requiring intervention.

[0064] Existing TVT and TVT-O techniques require mesh, which carries the risk of mesh exposure and erosion, and is expensive. TVT can easily damage the bladder during surgery, requiring cystoscopy to rule out bladder injury. In TVT-O, the sling passes through the obturator membrane, obturator muscle, and medial edge of the adductor muscles, posing a risk of nerve damage and a high incidence of postoperative groin pain.

[0065] This technology utilizes the body's own tissue for repair, does not require a mesh, is low-cost, has no risk of mesh exposure and erosion, has a short surgical path, only requires exposure of the anterior vaginal wall and the bladder side space and the bilateral descending pubic ligaments, has a low risk of bladder damage, does not require cystoscopy, has a low risk of nerve damage, has no risk of groin pain, and is easy to promote at the grassroots level.

[0066] The paraurethral fascia is fixed to the descending pubic ligament with an inverted "eight" linear suture of No. 7 silk thread. The suture does not cross at the midline of the urethra to avoid urethral obstruction. The body's own tissue is used for repair without mesh, and there is no risk of mesh exposure or erosion. The surgical path is short, and the risks of bladder injury, nerve damage, and postoperative pain are low.

[0067] In a second aspect, the present application discloses a device for treating SUI by performing a transvaginal mid-urethral parapubic ligament linear suspension procedure. The device comprises: a single or multiple processors, and a memory; the memory is used to store a single or multiple computer program instructions; when the single or multiple computer programs are executed by the single or multiple processors, the following steps are performed: S101: Locate the midline of the anterior vaginal wall and make a longitudinal incision along the midline of the anterior vaginal wall to the set distance below the transverse urethral groove to separate the bladder from the vaginal wall. S102: Separate the bladder and vaginal wall, then separate the left / right space of the bladder to obtain the free left / right mid-urethral fascia and expose the left / right lateral ligament of the descending pubic branch; S103: Pull the para-urethral fascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

[0068] It should be noted that the flowcharts and block diagrams in the accompanying drawings illustrate the possible implementation architectures, functions and operations of the systems, methods and computer program products according to various embodiments of the present disclosure. In this regard, each box in the flowchart or block diagram can represent a module, program segment, or a part of code, and the module, program segment, or a part of code contains one or more executable instructions for implementing the specified logical functions. It should also be noted that in some alternative implementations, the functions marked in the boxes can also occur in an order different from that marked in the accompanying drawings. For example, two boxes represented in succession can actually be executed substantially in parallel, and they can sometimes be executed in the opposite order, depending on the functions involved. It should also be noted that each box in the block diagram and / or flowchart, and the combination of boxes in the block diagram and / or flowchart, can be implemented using a dedicated hardware-based system that performs the specified functions or operations, or can be implemented using a combination of dedicated hardware and computer instructions.

[0069] In general, various example embodiments of the present disclosure may be implemented in hardware or dedicated circuitry, software, firmware, logic, or any combination thereof. Certain aspects may be implemented in hardware, while other aspects may be implemented in firmware or software that may be executed by a controller, microprocessor, or other computing device. When various aspects of the disclosed embodiments are illustrated or described as block diagrams, flow charts, or using some other graphical representation, it will be understood that the blocks, devices, systems, techniques, or methods described herein may be implemented, as non-limiting examples, in hardware, software, firmware, dedicated circuitry or logic, general-purpose hardware or a controller or other computing device, or some combination thereof.

[0070] Those skilled in the art will clearly understand that, for the convenience and brevity of description, the specific working processes of the systems, devices and units described above can refer to the corresponding processes in the aforementioned method embodiments and will not be repeated here.

[0071] In the several embodiments provided in this application, it should be understood that the disclosed systems, devices and methods can be implemented in other ways. For example, the device embodiments described above are merely schematic. For example, the division of the units is merely a logical function division. In actual implementation, there may be other division methods, such as multiple units or components can be combined or integrated into another system, or some features can be ignored or not executed. Another point is that the mutual coupling or direct coupling or communication connection shown or discussed can be an indirect coupling or communication connection through some interfaces, devices or units, which can be electrical, mechanical or other forms.

[0072] The units described as separate components may or may not be physically separate, and the components shown as units may or may not be physical units, that is, they may be located in one place or distributed across multiple network units. Some or all of these units may be selected to achieve the purpose of this embodiment according to actual needs.

[0073] In addition, the functional units in the various embodiments of the present invention may be integrated into a single processing unit, each unit may exist physically separately, or two or more units may be integrated into a single unit. The aforementioned integrated units may be implemented in the form of hardware or software functional units.

[0074] The exemplary embodiments of the present disclosure described in detail above are merely illustrative and not restrictive. Those skilled in the art will appreciate that various modifications and combinations may be made to these embodiments or their features without departing from the principles and spirit of the present disclosure, and such modifications should fall within the scope of the present disclosure.

Claims

1. A system for treating SUI by transvaginal midurethral parapubic ligament linear suspension, characterized in that: The system comprises: Positioning and dissection processing unit 101: used to longitudinally incise the anterior vaginal wall mucosa along the midline of the anterior vaginal wall to a set depth below the transverse urethral groove; Separation and exposure processing unit 102: used to separate the bladder and vaginal wall, and then separate the left / right space of the bladder to obtain free left / right mid-urethra parafascia and expose the left / right lateral ligament of the descending pubic branch; The suspension processing unit 103 is used to respectively pull up the parafascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

2. The system for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 1, characterized in that: The suturing and fixation in the suspension processing unit 103 is an inverted "eight" suturing, specifically: the fascia beside the left / right mid-urethra is pulled up to the left / right lateral ligament of the descending pubic branch obliquely above the urethra, so that the pulled fascia on the left and right sides form an inverted "eight" shape, and then sutured and fixed; Optionally, the stitches for suturing and fixing on both sides do not cross at the midline of the urethra, and are separated by a gap of a set width at the midline of the urethra.

3. The system for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 2, characterized in that: The angle between the fascia and the urethra level after lifting is 10°~30°; Optionally, the angle between the fascia and the urethra level is 25° after lifting; Optionally, the fascia beside the left / right middle urethra is pulled up to the left / right lateral ligament of the descending pubic branch obliquely above the urethra in the direction of the human body cross section and sutured and fixed; optionally, No. 7 silk thread is used for the suture fixation.

4. The system for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 1, characterized in that: The suture fixing lines in the suspension processing unit 103 do not cross at the urethral midline, and the fixing lines on both sides are separated by a gap of a set width at the urethral midline; Optionally, the set width is 0.3-1 cm; Optionally, the set width is 0.5 cm.

5. The system for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 1, characterized in that: The set depth is 0.2~0.5cm; Optionally, the set depth is 0.3 cm.

6. The system for treating SUI by transvaginal mid-urethral parapubic ligament linear suspension according to claim 1, characterized in that: The system further comprises a hemostatic suturing unit 104 for suturing the anterior vaginal wall mucosa along the midline of the anterior vaginal wall.

7. The system for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 6, characterized in that: The specific steps for suturing the anterior vaginal wall mucosa are: first, use continuous suture to stop bleeding, and then trim the excess vaginal wall tissue; then use continuous locking suture to suture the autologous tissue along the urethra for the second time.

8. A device for treating SUI by transvaginal midurethral parapubic ligament linear suspension, characterized in that: The apparatus comprises: a single or multiple processors, and a memory; the memory is used to store a single or multiple computer program instructions; when the single or multiple computer programs are executed by the single or multiple processors, the following steps are performed: S101: Locate the midline of the anterior vaginal wall and make a longitudinal incision along the midline of the anterior vaginal wall to the set distance below the transverse urethral groove to separate the bladder from the vaginal wall. S102: Separate the bladder and vaginal wall, then separate the left / right space of the bladder to obtain the free left / right mid-urethral fascia and expose the left / right lateral ligament of the descending pubic branch; S103: Pull the para-urethral fascia of the left / right middle urethra to the left / right lateral ligament of the descending pubic branch obliquely above the urethra and suture and fix it.

9. The device for treating SUI by transvaginal midurethral parapubic ligament linear suspension according to claim 8, characterized in that: When the single or multiple computer programs are executed by the single or multiple processors, the following steps are performed: S101: Locate the midline of the anterior vaginal wall and make a longitudinal incision along the midline of the anterior vaginal wall to the set distance below the transverse urethral groove; S102: Separate the bladder and vaginal wall, then separate the left / right space of the bladder to obtain the free left / right mid-urethral fascia and expose the left / right lateral ligament of the descending pubic branch; S103: Pull the left / right mid-urethral fascia up to the left / right lateral ligament of the descending pubic branch obliquely above the urethra, so that the pulled fascia on the left and right sides form an inverted "eight" shape, and then suture and secure. The suture stitches on both sides do not cross at the urethral midline, and a gap of a set width is separated at the urethral midline. S104: Suture the anterior vaginal wall mucosa along the midline of the anterior vaginal wall.

10. The device for treating SUI by transvaginal mid-urethral parapubic ligament linear suspension according to claim 8, characterized in that: The device comprises: a positioning component, a dissecting component, a separating component, and a suturing component; The positioning components include: a microscope, a camera, and a positioning computer; The dissection tools include: tissue scissors, microscissors, stripping scissors, electric knife, No. 10 blade, fine-toothed forceps, mosquito curved forceps, curved hemostatic forceps, curved vascular forceps, The separating parts include: No. 10 knife handle, vaginal pressure plate, vaginal retractor The suture components include: No. 7 silk thread, 12×20 angle needle, 6×10 round needle, needle holder, and 2-0 absorbable surgical suture.

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