An iliopectineal ligament suspension system and apparatus utilizing the round ligament complex
The iliopectine ligament suspension system using the round ligament complex, which utilizes laparoscopic identification and suturing of autologous tissue to construct the round ligament complex, solves the operational difficulties and complications of existing pelvic organ prolapse surgeries, and provides a low-cost, low-damage pelvic floor reconstruction solution.
Patent Information
- Authority / Receiving Office
- CN · China
- Patent Type
- Applications(China)
- Current Assignee / Owner
- 363 HOSPITAL
- Filing Date
- 2026-04-24
- Publication Date
- 2026-06-05
AI Technical Summary
Existing pelvic organ prolapse surgeries, such as sacral fixation, are difficult to perform, have a high recurrence rate, and are prone to complications. Furthermore, traditional mesh suspension methods pose risks of mesh exposure, erosion, and infection, making them difficult to meet clinical needs.
The iliopubic ligament suspension system using the round ligament complex is constructed by identifying and suturing autologous tissue under laparoscopy. The iliopubic ligament is then sutured with non-absorbable sutures to simulate the round ligament of the uterus suspending the mid-pelvic cavity. Different suturing methods are combined to meet the needs of patients who wish to retain or not retain the uterus, avoiding mesh exposure and erosion.
It achieves low-cost, low-damage, and low-recurrence pelvic organ suspension, reduces the risk of postoperative pain, adapts to different patient conditions, and provides a safe, minimally invasive, and easy-to-learn pelvic floor reconstruction surgery option.
Smart Images
Figure CN122140310A_ABST
Abstract
Description
Technical Field
[0001] This application relates to the field of biotechnology, specifically to an iliopectine ligament suspension system and device utilizing the round ligament complex. Background Technology
[0002] Pelvic organ prolapse (POP) is a condition caused by dysfunction of the pelvic floor support structures and tissues, resulting in the drooping of pelvic organs. Clinically, it manifests as a prolapsed mass, and may be accompanied by urinary, bowel, and sexual dysfunction, impacting the patient's quality of life. With an aging population and increased life expectancy, POP has gradually become a significant health concern for middle-aged and elderly women, and a public health issue that cannot be ignored.
[0003] Based on the three-compartment principle, mid-pelvic and anterior pelvic defects are the most common types of pelvic inflammatory disease (POP), and apical repair is crucial in POP repair surgery. In clinical practice, inadequate mid-pelvic repair is often a key factor in recurrence. Currently, commonly used surgical methods include sacrospinous ligament suspension, high sacroligament fixation, sacral fixation, and iliopectineal ligament suspension. Sacral fixation is currently recognized as the "gold standard" surgical method for treating mid-pelvic defects due to its advantages such as low recurrence rate and better alignment with the physiological axis of the vagina. However, this method still has some problems, such as difficult operation, long learning curve, and possible intraoperative and postoperative complications and functional impairments. The most frequently reported complications include defecation disorders and stress urinary incontinence (SUI), as well as bleeding caused by presacral vascular injury, which deters many primary care physicians. Compared with sacral fixation, laparoscopic iliopectineal ligament suspension, as a new, minimally invasive, safe, and effective procedure, provides surgeons with a new option. This surgery, with its advantages of simple operation, less intraoperative bleeding, and low risk of damage, has gradually been used by doctors in clinical treatment and has initially achieved good results. However, most of these studies use mesh to suspend and fix the cervix or vaginal stump to the bilateral iliopectineal ligaments. In the long run, there are still problems such as mesh exposure and erosion, severe pelvic pain, infection, vaginal scarring, narrowing, deformation, dyspareunia, and patient discomfort. In severe cases, additional surgical intervention is required to solve the difficulties, which has become an important problem for pelvic floor reconstruction surgeons. Summary of the Invention
[0004] To address the above problems, this invention provides an iliopubic ligament suspension system utilizing the round ligament complex, specifically comprising: Acquisition Unit: Acquires real-time laparoscopic images of the patient; First identification unit: Identifies the region at the junction of the round ligament and the lateral umbilical ligament based on the real-time laparoscopic images; Separation Unit: The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein is identified; Anchor point unit: The iliopubic ligaments on both sides are obtained by detecting and locating the area surrounding the external iliac vein; Suture unit: Non-absorbable sutures are sutured to the iliopubic ligaments on both sides as a backup; Round ligament complex construction unit: The peritoneum is identified by the broad ligament and opened to the vesicouterine peritoneal reflection. The concomitant round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until they reach the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex.
[0005] In the round ligament complex construction unit, an autologous tissue suspension system (round ligament complex) is constructed with the round ligament through the non-absorbable suture and anchored on the iliopectineal ligament to simulate the suspension effect of the round ligament of the uterus on the midpelvic cavity and repair midpelvic defects. The system also includes a uterine unit: when the patient is uterus-preserving, the uterine position is identified, and the non-absorbable suture of the round ligament complex is continuously sutured to the anterior leaf of the round ligament and broad ligament on the same side until it reaches K centimeters to the side of the uterus, where K is a natural number greater than 0.5 centimeters. The avascular area of the posterior leaf of the broad ligament on the same side is identified, and the suture is passed through the avascular area of the posterior leaf of the broad ligament on the same side and sutured to the ipsilateral uterine-sacro ligament complex.
[0006] The system also includes a uterus-free unit: when the patient does not retain the uterus, after hysterectomy, the location of the cardinal sacral ligament and vaginal stump is identified, and the cardinal sacral ligament and vaginal stump are sutured together with absorbable sutures to form a vaginal stump-cardinal sacral ligament complex. Then, the anterior leaf of the round ligament and broad ligament on the same side are continuously sutured together with non-absorbable sutures until they reach the side of the vaginal stump, and the vaginal stump-cardinal sacral ligament complex on the same side is sutured and fixed. The vaginal stump-cardinal sacral ligament complex and the round ligament complex are then sutured together with non-absorbable sutures to assist in adjusting the tension of the bilateral suspensions through the vagina.
[0007] The system also includes a pelvic peritoneum closure unit, identification of the pelvic floor peritoneum, continuous suturing of the pelvic floor peritoneum with absorbable sutures, and embedding non-absorbable sutures behind the peritoneum.
[0008] The identification is performed by a trained object detection model to obtain the identification result. The object detection model includes any one or more of the following: Deformable DETR, Cascade R-CNN, Mask R-CNN, Swin-Transformer, YOLOX, PP-YOLO, YOLOv7, EfficientDet, CenterNet, and DETR.
[0009] The training process of the target recognition model is as follows: acquire the laparoscopic image dataset and labels; input the laparoscopic image dataset and labels into the target detection model to be trained for training; compare the predicted labels of the target detection model with the real labels to calculate the loss function; iterate the model training until the loss function remains unchanged to obtain the trained target detection model; wherein the laparoscopic images and labels include any one or more of the following: the junction area of the round ligament and the lateral umbilical ligament, the external iliac vein, the iliopubic ligament, the broad ligament, the vesicouterine peritoneal reflection, the anterior leaf of the broad ligament, the posterior leaf of the broad ligament, the cardinal sacral ligament complex, the upper part of the cervix and vagina, the vaginal stump, the pelvic floor peritoneum, and the uterus.
[0010] The purpose of this invention is to provide a computer device comprising a memory, a processor, and a computer program or instructions stored in the memory, wherein the computer program or instructions are executed by the processor to implement a method for iliopectineal ligament suspension of the round ligament complex. Acquire real-time laparoscopic images of the patient; The region at the junction of the round ligament and the lateral umbilical ligament is identified based on the real-time images from the laparoscopy. The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein and broad ligament are identified. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; Non-absorbable sutures were sutured to the iliopubic ligaments on both sides as a backup; The peritoneum is identified by the broad ligament and opened to the vesicouterine peritoneal reflection. The conjoined round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until they reach the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex.
[0011] The purpose of this invention is to provide an iliopectine ligament suspension device for the round ligament complex, comprising a memory, a processor, and a computer program stored in the memory, wherein the computer program or instructions are controlled and executed by the processor, and a suture device, non-absorbable suture, a detection lens, tissue scissors, and peritoneal clamps. The suture device, suture, detection lens, tissue scissors, and peritoneal clamps are controlled and executed by the computer program to achieve the following steps for iliopectine ligament suspension of the round ligament complex: Real-time laparoscopic images of the patient are acquired through the detection lens; The real-time laparoscopic images are used by a computer program to identify the area at the junction of the round ligament and the lateral umbilical ligament. The peritoneum at the junction of the round ligament and the lateral umbilical ligament is opened with tissue scissors and peritoneal forceps, loose tissue is separated, and the external iliac vein is identified by a detection lens and the computer program. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; The suture device is combined with non-absorbable sutures, which are then sutured to the iliopubic ligaments on both sides as a backup. Based on the broad ligament, the peritoneum is identified by a computer program and opened by tissue scissors and peritoneal forceps until the computer program detects and identifies the vesicouterine peritoneal reflection. The contralateral round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until the computer program detects the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex. Optionally, the process of suspending the iliopectine ligament of the round ligament complex also includes hemostatic forceps, needle holders, and caliper forceps for clamping and controlling the tissue, assisting in suturing, and vascular hemostasis; and a scalpel for separating the tissue.
[0012] Advantages of this invention: 1. The system or device of this invention performs laparoscopic surgery. This system can construct a round ligament complex by suturing autologous round ligament tissue using a thick, non-absorbable suture. The constructed round ligament complex replaces the mesh, resulting in lower costs (eliminating the need for additional mesh costs) and eliminating the risk of mesh exposure and erosion. During the construction of the round ligament complex, the system utilizes the magnification capabilities of laparoscopy to fully expose the iliopubic ligament, ensuring safe suture anchoring points. One end of the cervical or vaginal stump-cardiac ligament complex is precisely suspended to the mid-lateral portion of both iliopubic ligaments, thereby correcting mid-pelvic defects and pelvic organ prolapse. Postoperative injury and pain risks are low, the learning curve is short, and it is easily promoted at the grassroots level.
[0013] 2. The system or device of the present invention performs different suturing methods on the constructed round ligament complex for patients who retain their uterus and those who do not, respectively (bilateral suturing near the uterus, vaginal end suturing), which is more in line with the application scenarios of different patients in clinical practice.
[0014] 3. The system or device of the present invention can accurately identify different sites through laparoscopic images or real-time images for determining anchor points and suture points. The system also includes a visualization and prompting unit, which displays anchor points and suture points through visualization and provides prompts when the suture device selects the wrong tissue or point, providing assistance or teaching for inexperienced doctors in constructing the round ligament complex. Attached Figure Description
[0015] To more clearly illustrate the technical solutions in the embodiments of the present invention, the accompanying drawings used in the description of the embodiments will be briefly introduced below. Obviously, the accompanying 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 effort.
[0016] Figure 1This is a schematic diagram of the iliopubic ligament suspension system of the round ligament complex provided in an embodiment of the present invention; Figure 2 A schematic diagram of a computer device provided in an embodiment of the present invention; Figure 3 The selection of anchoring points for the hip-pubic ligament and round ligament without a uterus, as provided in the embodiments of the present invention; Figure 4 The junction region of the round ligament and the lateral umbilical ligament and the iliopubic ligament provided in the embodiments of the present invention; Figure 5 Construction of a round ligament complex for uterine preservation provided in embodiments of the present invention; Figure 6 Construction of a round ligament complex without uterine preservation, as provided in embodiments of the present invention; Figure 7 This is a comparison of the pelvic cavity before and after surgery without uterine preservation, provided in an embodiment of the present invention. Detailed Implementation
[0017] To enable those skilled in the art to better understand the present invention, the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings.
[0018] In some of the processes described in the specification, claims, and accompanying drawings of this invention, multiple operations appearing in a specific order are included. However, it should be clearly understood that these operations may not be executed in the order they appear herein, or may be executed in parallel. The operation numbers, such as S101, S102, etc., are merely used to distinguish different operations and do not represent any execution order. Furthermore, these processes may include more or fewer operations, and these operations may be executed sequentially or in parallel. It should be noted that the descriptions such as "first," "second," etc., in this document are used to distinguish different messages, devices, modules, etc., and do not represent a sequential order, nor do they limit "first" and "second" to different types.
[0019] Figure 1 A schematic diagram of the iliopubic ligament suspension system of the round ligament complex provided in this embodiment of the invention specifically includes: Acquisition Unit: Acquires real-time laparoscopic images of the patient; First identification unit: Identifies the region at the junction of the round ligament and the lateral umbilical ligament based on the real-time laparoscopic images; Separation Unit: The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein is identified; Anchor point unit: The iliopubic ligaments on both sides are obtained by detecting and locating the area surrounding the external iliac vein; Suture unit: Non-absorbable sutures are sutured to the iliopubic ligaments on both sides as a backup; Round ligament complex construction unit: The peritoneum is identified by the broad ligament and opened to the vesicouterine peritoneal reflection. The concomitant round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until they reach the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex.
[0020] An autologous tissue suspension system (round ligament complex) is constructed by means of the non-absorbable suture and the round ligament, and anchored on the iliopectineal ligament to simulate the suspension effect of the uterine round ligament on the midpelvic cavity, thereby repairing midpelvic defects.
[0021] Repairing midpelvic defects involves anchoring the round ligament complex to the iliopectineal ligament, simulating the suspension effect of the uterine round ligament on the midpelvic cavity.
[0022] An autologous tissue suspension system is constructed using readily available and inexpensive non-absorbable sutures and round ligaments, and anchored to the iliopubic ligament to repair midpelvic defects.
[0023] In one embodiment, the real-time laparoscopic image is a surgical environment image for mid-pelvic repair, and the anchor point is selected as the iliopubic ligament on both sides of the area surrounding the external iliac vein, such as... Figure 3 As shown, the area at the junction of the round ligament and the lateral umbilical ligament ( Figure 4 (left image) and iliopubic ligament ( Figure 4 (The image on the right).
[0024] In one embodiment, the system further includes a uterine unit: when the patient is uterus-preserving, the uterine position is identified, and the non-absorbable sutures of the round ligament complex (non-absorbable sutures fixed to the iliopectine ligament) are continuously sutured to the contralateral round ligament and the anterior leaf of the broad ligament up to K centimeters lateral to the uterus, where K is a natural number greater than 0.5 centimeters. Figure 3 The lower example of bilateral suture shown identifies the avascular area of the ipsilateral posterior leaf of the broad ligament, passes through the ipsilateral avascular area of the ipsilateral posterior leaf of the broad ligament, and is sutured and fixed to the ipsilateral uterine-sacro ligament complex.
[0025] Both sides of the round ligament complex are sutured until they reach the lateral side of the uterus, where they are fixed to the cardinal uterosacral ligament. The cardinal uterosacral ligament complex consists of the cardinal and sacral ligaments of the uterus. The cardinal uterosacral ligaments are naturally attached to the cervix and the top of the vagina, and are suspended by the round ligament complex to the iliopubic ligament of the pelvis.
[0026] Optionally, non-absorbable sutures of the round ligament complex are sutured from both sides of the round ligament complex to 1 cm beside the uterus.
[0027] In one embodiment, the system further includes a uterus-free unit: when the patient is a uterus-free patient, after uterine removal, the locations of the cardinal-sacral ligament and vaginal stump are identified, and the cardinal-sacral ligament and vaginal stump are constructed by figure-eight sutures using absorbable sutures to form a vaginal stump-cardinal-sacral ligament complex. Then, the contralateral round ligament and the anterior leaf of the broad ligament are continuously sutured using non-absorbable sutures until reaching the side of the vaginal stump, and finally sutured and fixed to the ipsilateral vaginal stump-cardinal-sacral ligament complex. Figure 3 The example shown above, involving bilateral suture, assists in adjusting the tension of the bilateral suspensions via the vagina.
[0028] In one embodiment, the system further includes closing the pelvic peritoneum unit, identifying the pelvic floor peritoneum, continuously suturing the pelvic floor peritoneum with absorbable sutures, and embedding non-absorbable sutures behind the peritoneum.
[0029] The round ligament complex, which preserves the uterus, is constructed as follows: Figure 5 As shown, the round ligament complex without preserving the uterus is constructed as follows: Figure 6 As shown; In one embodiment, the non-absorbable suture is W4843 non-absorbable suture, and the absorbable suture is 2-0 absorbable suture. For patients with uterus preservation, a single non-absorbable suture is used when constructing the round ligament complex and the uterosacral ligament complex; for patients without uterus preservation, non-absorbable sutures are used for continuous suturing when constructing the round ligament complex, and absorbable sutures are used for continuous suturing when constructing the vaginal stump-uterosacral ligament complex; when closing the pelvic and abdominal cavities, for patients with uterus preservation, absorbable sutures are used for continuous pelvic peritoneum suturing, and for patients without uterus preservation, continuous pelvic peritoneum suturing is performed using the absorbable suture used to construct the vaginal stump-uterosacral ligament complex or using a second absorbable suture.
[0030] In one embodiment, a comparison of pre- and post-operative conditions in patients who do not retain their uterus is provided. Figure 7 As shown, after suspension by the iliopubic ligament suspension system utilizing the round ligament complex in this invention, the pelvic tissues are suspended by simulating the original (natural tissue) traction force, providing a good repair environment for mid-pelvic repair.
[0031] In one embodiment, the above recognition is performed by a trained object detection model to obtain the recognition result. The object detection model includes any one or more of the following: Deformable DETR, Cascade R-CNN, Mask R-CNN, Swin-Transformer, YOLOX, PP-YOLO, YOLOv7, EfficientDet, CenterNet, and DETR.
[0032] The training process of the target recognition model is as follows: acquire the laparoscopic image dataset and labels; input the laparoscopic image dataset and labels into the target detection model to be trained for training; compare the predicted labels of the target detection model with the real labels to calculate the loss function; iterate the model training until the loss function remains unchanged to obtain the trained target detection model; wherein the laparoscopic images and labels include any one or more of the following: the junction area of the round ligament and the lateral umbilical ligament, the external iliac vein, the iliopubic ligament, the broad ligament, the vesicouterine peritoneal reflection, the anterior leaf of the broad ligament, the posterior leaf of the broad ligament, the cardinal sacral ligament complex, the upper part of the cervix and vagina, the vaginal stump, the pelvic floor peritoneum, and the uterus.
[0033] For target detection models, when multiple targets are included in the same image field of view, the size of the image field of view is adjusted to perform single target recognition or multi-target recognition. For image fields of different layers, the corresponding target detection models are trained using images of different layers. In the application process, target recognition is performed by converting the target detection model. Specifically, when identifying the area at the junction of the round ligament and the lateral umbilical ligament in the first layer and identifying the external iliac vein or broad ligament in the second layer after opening the peritoneum, the first target detection model and the second / third target detection model are used for recognition.
[0034] In one specific embodiment, the iliopubic ligament suspension procedure of the round ligament complex specifically includes: Determine the anchoring point: Open the peritoneum in the V-shaped area at the junction of the round ligament and the lateral umbilical ligament, separate the loose tissue, and locate and expose the iliopubic ligament anteroinferior to the external iliac vein. Fix it to the bilateral iliopubic ligaments with non-absorbable W4843 figure-of-eight sutures for later use; Construction of the round ligament complex: The peritoneum is opened along the V-shaped area at the junction of the round ligament and the lateral umbilical ligament. The peritoneum is then opened on the ventral side of the broad ligament to the vesicouterine peritoneal reflection. The concomitant round ligament and the corresponding anterior leaf of the broad ligament are continuously sutured with spare W4843 non-absorbable suture to the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to form a complex formed by the round ligament and the non-absorbable suture W4843.
[0035] Cervical / vaginal stump-cardiac ligament complex: Preservation of the uterus: When the W4843 suture on the round ligament complex is sutured from both sides to 1 cm beside the uterus, it passes posteriorly through the avascular area of the broad ligament and sutures the ipsilateral cardinal ligament complex. Without uterus preservation: The cardinal sacral ligament is sutured to the ipsilateral vaginal stump in a figure-eight pattern using 2-0 absorbable sutures to form a complex. The round ligament complex is then sutured to the vaginal stump-cardinal sacral ligament complex. The vaginal apex is pushed up through the vagina to adjust the tension of the bilateral suspension. Closure of the pelvic and abdominal peritoneum: The pelvic floor peritoneum is continuously sutured with 2-0 absorbable sutures, and Ethiban W4843 polyester sutures are embedded in the retroperitoneum.
[0036] In one specific embodiment, preoperative preparation included: sutures - Ethiban W4843 polyester sutures, 2-0 absorbable sutures; needles - 12×20mm large triangular needles. The comparison results with the closest existing surgical method are shown in Table 1.
[0037] Table 1
[0038] The iliopubic ligament suspension system for the round ligament complex proposed in this invention is characterized by standardization, normalization, humanization, and precision. Standardization: Pelvic floor reconstruction using autologous tissue (non-absorbable linear ligament complex as a new load-bearing beam, iliopubic ligament anchoring point, cervical / vaginal end-cardiac ligament complex as a new apical support) avoids mesh erosion and exposure, as well as the risk of secondary injury and pain. It is economical, feasible, and worth promoting.
[0039] Standardization: In the three-level support of the vagina, the core position of the reconstruction of the vaginal apex level I is reflected.
[0040] Humanized: The #2 non-absorbable suture (Esibon W4843) replaces the expensive biological mesh, with high tension, permanent support, less damage, and lower cost, making it suitable for use in primary hospitals.
[0041] Precision: Laparoscopic surgery provides a clear field of vision, and the surgical procedure is performed according to the principles of anatomy, layer, and interspace to locate ligaments, making the operation safe and easy to master.
[0042] In one specific embodiment, 21 patients with a POP-Q score ≥ III and predominantly mid-pelvic organ prolapse at the level I were selected from the Department of Gynecology of the 363 Hospital between March 2022 and September 2025 (13 of whom also had stress urinary incontinence). All 21 patients underwent laparoscopic bilateral iliopubic ligament suspension using the round ligament complex (20 cases underwent total hysterectomy, and 1 case retained the uterus). The 13 patients with stress urinary incontinence underwent transvaginal mid-urethral parapubic ligament linear suspension, anterior and posterior vaginal wall repair, and perineal repair in addition to the laparoscopic iliopubic ligament suspension. The differences in quality of life before and after surgery were compared using the pelvic floor function questionnaire (PFDI-20, PFIQ-7 scale). For patients with sexual activity, the differences in PISQ-12 scale scores before and after surgery were compared. Perioperative indicators and follow-up efficacy were statistically analyzed.
[0043] All 21 patients successfully underwent surgery, 20 of whom were successfully followed up, and 1 was lost to follow-up. The patients ranged in age from 49 to 86 years, with a mean age of 63.86 ± 12.14 years. The follow-up period after surgery was ≥ 6 months.
[0044] The treatment efficacy of pelvic floor prolapse was assessed using the POP-Q staging method: 18 cases were cured (90% anatomical cure rate), and 2 cases relapsed (10% recurrence rate). 13 cases had preoperative urinary incontinence; postoperative treatment results showed 12 cases cured (1 lost to follow-up), a cure rate of 100%; urinary retention (catheter removed 72 hours postoperatively): 1 case experienced short-term postoperative urinary retention, which resolved with continued catheterization for 1 week (incidence rate 5%); 1 case of right lower extremity venous thrombosis complicated by pulmonary embolism (incidence rate 5%); 1 case of dyspareunia (11 cases had sexual intercourse, 9 did not). No serious complications such as urinary leakage, suture exposure, or injury to the intestines, bladder, or ureter were found.
[0045] Laparoscopic bilateral iliopubic ligament suspension using the round ligament complex provides a new approach and option for the treatment of pelvic organ prolapse. It is minimally invasive, simple, safe, effective, and easy to learn and master.
[0046] In one embodiment, the acquisition unit acquires real-time laparoscopic images and transmits them to the first recognition unit. Upon receiving the real-time laparoscopic images, the first recognition unit identifies the region where the round ligament and lateral umbilical ligament meet, generating a bounding box to indicate the location of this region. The laparoscopic image with the bounding box is then transmitted to the separation unit. Based on the real-time laparoscopic image with the bounding box, the separation unit locates the target position and generates separation instructions or programs to control the medical devices. Simultaneously, the separation unit performs a parallel external iliac vein recognition task, generating an external iliac vein bounding box in the real-time laparoscopic image. This real-time laparoscopic image with the external iliac vein bounding box is then transmitted to the anchoring unit. Upon receiving the real-time laparoscopic image with the external iliac vein bounding box, the anchoring unit identifies the iliopubic ligament to obtain its location. The system generates anchoring procedures or instructions, inputting real-time laparoscopic images of the iliopubic ligament location and the anchoring procedures or instructions to the suturing unit. The suturing unit further generates suturing instructions based on the anchoring procedures or instructions to control the medical devices in suturing non-absorbable sutures. Simultaneously, the first identification unit identifies the broad ligament and peritoneum, generating separation procedures or instructions, which are input to the separation unit. The separation unit generates control procedures or instructions to open the peritoneum and identify the vesicouterine peritoneal reflection, obtaining a laparoscopic image with the location of the vesicouterine peritoneal reflection, which is input to the suturing unit. The suturing unit receives the laparoscopic image with the location of the vesicouterine peritoneal reflection and the suturing purpose procedure or instructions, generating suturing step instructions to continuously suture the non-absorbable sutures onto the contralateral round ligament and the anterior leaf of the broad ligament until it reaches the side of the vaginal stump or the side of the uterus, tightening the round ligament to obtain the round ligament complex. For uterine units and units without a uterus, the same process of identification and corresponding instruction generation is performed by the first identification unit and the suturing unit. Each unit can integrate its own microprocessor to process tasks, or it can call upon the shared central processing unit to process its own task processes, with the central processing unit handling task allocation and control.
[0047] Figure 2 An embodiment of the present invention provides a schematic diagram of a computer device, specifically including: A memory and a processor; the memory is used to store program instructions; the processor is used to invoke the program instructions, when the program instructions are executed, for the iliopectine ligament suspension method of the round ligament complex: Acquire real-time laparoscopic images of the patient; The region at the junction of the round ligament and the lateral umbilical ligament is identified based on the real-time images from the laparoscopy. The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein is identified. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; Non-absorbable sutures were sutured to the iliopubic ligaments on both sides as a backup; Identify the peritoneum through the broad ligament and open the peritoneum to the vesicouterine peritoneal reflection. Use spare non-absorbable sutures to continuously suture the contralateral round ligament and the anterior leaf of the broad ligament until they reach the side of the vaginal stump or the side of the uterus. Tighten the round ligament to obtain the round ligament complex.
[0048] When the patient is uterus-preserving, identify the location of the uterus, and continuously suture the non-absorbable suture of the round ligament complex to the anterior leaf of the round ligament and broad ligament on the same side until it reaches K cm to the side of the uterus, where K is a natural number greater than 0.5 cm. Identify the avascular area of the posterior leaf of the broad ligament on the same side, pass through the avascular area of the posterior leaf of the broad ligament on the same side, and suture it to the ipsilateral uterosacral ligament complex.
[0049] When the patient does not retain the uterus, after hysterectomy, the location of the cardinal sacral ligament and vaginal stump is identified. The cardinal sacral ligament and vaginal stump are sutured together with absorbable sutures to form a vaginal stump-cardinal sacral ligament complex. Then, the anterior leaf of the round ligament and broad ligament on the same side are continuously sutured together with non-absorbable sutures until they reach the side of the vaginal stump. The vaginal stump-cardinal sacral ligament complex on the same side is sutured and fixed. The vaginal stump-cardinal sacral ligament complex and the round ligament complex are then sutured together with non-absorbable sutures to assist in adjusting the tension of the bilateral suspensions through the vagina.
[0050] Close the pelvic peritoneum, identify the pelvic floor peritoneum, and continuously suture the pelvic floor peritoneum with absorbable sutures, embedding the non-absorbable sutures behind the peritoneum.
[0051] In one embodiment, the system or device controls the execution of each unit through computer instructions or programs. The system is set in the central processor of the surgical robot. The surgical robot performs fully automatic image data acquisition, identification, tissue separation, and suturing steps according to preset computer instructions or programs; or, under the guidance of doctors or other medical personnel, the robot or robotic arm performs semi-automatic suturing steps, including doctors and other medical personnel judging whether to adjust the target identification position based on real-time images. When adjustment is required, the system accepts the adjusted target position and performs suturing and assists in controlling the sutures on one side of the main sacral ligament complex through the adjusted target position.
[0052] In one embodiment, during automated surgery, the surgical robot identifies the spatial position of autologous tissue by constructing three-dimensional coordinates, and detects the two-dimensional coordinates of the upper, middle and lower planes of the autologous tissue and the three-dimensional spatial coordinates of different autologous tissues in front and behind in real time, which is used to simulate the doctor's judgment of the spatial position of autologous tissue from the surgical field of vision during surgery.
[0053] In one embodiment, laparoscopic images are acquired by a machine, and doctors or other medical staff use the laparoscopic images to help mark tissue locations. The system receives the marked tissue locations, performs suturing tasks, and completes the construction of autologous tissue.
[0054] In one embodiment, the system or device of the present invention is used to assist suturing. Laparoscopic images are acquired by a machine, and the system or device displays the recognition results after recognizing the tissue structure, identifying the corresponding structural points, including anchor points, segmentation points, and suture points. Doctors can use the visual identifiers to carry out the construction process of the round ligament complex, providing assisted suturing for doctors with insufficient experience, and also helping to teach the construction of the round ligament complex.
[0055] This invention also discloses an iliopectine ligament suspension device for the round ligament complex, comprising a memory, a processor, and a computer program stored in the memory. The computer program or instructions are executed by the processor. The device includes a suture device, non-absorbable sutures, a detection lens, tissue scissors, and peritoneal clamps. The suture device, sutures, detection lens, tissue scissors, and peritoneal clamps are controlled by the computer program to perform the steps of iliopectine ligament suspension of the round ligament complex. Real-time laparoscopic images of the patient are acquired through the detection lens; The real-time laparoscopic images are used by a computer program to identify the area at the junction of the round ligament and the lateral umbilical ligament. The peritoneum at the junction of the round ligament and the lateral umbilical ligament is opened with tissue scissors and peritoneal forceps, loose tissue is separated, and the external iliac vein is identified by a detection lens and the computer program. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; The suture device is combined with non-absorbable sutures, which are then sutured to the iliopubic ligaments on both sides as a backup. Based on the broad ligament, the peritoneum is identified by a computer program and opened by tissue scissors and peritoneal forceps until the computer program detects and identifies the vesicouterine peritoneal reflection. The contralateral round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until the computer program detects the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex. Optionally, the process of suspending the iliopectine ligament of the round ligament complex also includes hemostatic forceps, needle holders, and caliper forceps for clamping and controlling the tissue, assisting in suturing, and vascular hemostasis; and a scalpel for separating the tissue.
[0056] In one embodiment, the computer program used for identification is different from the computer program used for controlling the surgical instruments. The computer program used for identification is a target detection model, and the computer program used for controlling the surgical instruments is a program instruction for controlling the movement of the surgical instruments.
[0057] Real-time laparoscopic images of the patient are acquired through the detection lens; The real-time laparoscopic images are used by a first computer program to identify the area at the junction of the round ligament and the lateral umbilical ligament. The area at the junction of the round ligament and the lateral umbilical ligament is opened by tissue shears and peritoneal forceps controlled by the second computer program to separate the loose tissue, and the external iliac vein is identified by the detection lens and the first computer program. The first computer program detects and locates the iliopubic ligaments on both sides based on the area surrounding the external iliac vein; The second computer program controls the suture device to combine non-absorbable sutures and suture the non-absorbable sutures to the iliopubic ligaments on both sides as a backup. After identifying the broad ligament, the peritoneum is identified by the first computer program and the peritoneum is opened by the tissue scissors and peritoneal forceps controlled by the second computer program until the first computer program detects and identifies the vesicouterine peritoneal reflection. The second computer program continuously sutures the contralateral round ligament and the anterior leaf of the broad ligament with the spare non-absorbable suture until the first computer program detects the side of the vaginal stump or the side of the uterus. The second computer program controls the non-absorbable suture to tighten the round ligament, thus obtaining the round ligament complex.
[0058] The detection lens acquires real-time images, and the first computer program identifies the position of the uterus. The second computer program controls the continuous suturing of the non-absorbable suture of the round ligament complex with the anterior leaf of the round ligament and the broad ligament on the same side until it reaches K centimeters to the side of the uterus, where K is a natural number greater than 0.5 centimeters. The first computer program identifies the avascular area of the posterior leaf of the broad ligament on the same side. The second computer program controls the detection lens, suture device, and suture to pass through the avascular area of the posterior leaf of the broad ligament on the same side and suture and fix it to the ipsilateral uterine-sacro ligament complex.
[0059] When the patient does not retain the uterus, the imaging camera acquires real-time images, and a first computer program identifies the location of the cardinal sacral ligament and vaginal stump. A second computer program controls absorbable sutures and a suture device to suture the cardinal sacral ligament and vaginal stump together, forming a vaginal stump-cardinal sacral ligament complex. The second program then controls non-absorbable sutures and a suture device to continuously suture the anterior leaf of the round ligament and broad ligament on the same side until reaching the side of the vaginal stump, where it is sutured and fixed to the ipsilateral vaginal stump-cardinal sacral ligament complex. The vaginal stump-cardinal sacral ligament complex is then sutured to the round ligament complex using non-absorbable sutures to assist in adjusting the tension of the bilateral suspensions via the vagina.
[0060] The verification results of this verification embodiment show that assigning inherent weights to indications can improve the performance of this method compared to the default settings. Those skilled in the art will understand that, for the sake of convenience and brevity, the specific working processes of the systems, devices, and units described above can be referred to the corresponding processes in the foregoing method embodiments, and will not be repeated here. 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 illustrative; for example, the division of units is merely a logical functional division, and in actual implementation, there may be other division methods. For example, multiple units or components may be combined or integrated into another system, or some features may be ignored or not executed. Furthermore, the displayed or discussed mutual coupling or direct coupling or communication connection may be through some interfaces, indirect coupling or communication connection of devices or units, and may be electrical, mechanical, or other forms. The units described as separate components may or may not be physically separated; 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 the units can be selected according to actual needs to achieve the purpose of this embodiment. Furthermore, the functional units in the various embodiments of the present invention can be integrated into one processing unit, or each unit can exist physically separately, or two or more units can be integrated into one unit. The integrated units described above can be implemented in hardware or as software functional units. Those skilled in the art will understand that all or part of the steps in the various methods of the above embodiments can be implemented by a program instructing related hardware. This program can be stored in a computer-readable storage medium, which may include: read-only memory (ROM), random access memory (RAM), a magnetic disk, or an optical disk, etc.
[0061] Those skilled in the art will understand that all or part of the steps in the methods of the above embodiments can be implemented by a program instructing related hardware. The program can be stored in a computer-readable storage medium, such as a read-only memory, a disk, or an optical disk.
[0062] The computer device provided by the present invention has been described in detail above. For those skilled in the art, there will be changes in the specific implementation and application scope based on the ideas of the embodiments of the present invention. Therefore, the content of this specification should not be construed as a limitation of the present invention.
Claims
1. An iliopubic ligament suspension system utilizing the round ligament complex, characterized in that, include: Acquisition Unit: Acquires real-time laparoscopic images of the patient; First identification unit: Identifies the region at the junction of the round ligament and the lateral umbilical ligament based on the real-time laparoscopic images; Separation Unit: The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein is identified; Anchor point unit: The iliopubic ligaments on both sides are obtained by detecting and locating the area surrounding the external iliac vein; Suture unit: Non-absorbable sutures are sutured to the iliopubic ligaments on both sides as a backup; Round ligament complex construction unit: The peritoneum is identified by the broad ligament and opened to the vesicouterine peritoneal reflection. The concomitant round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until they reach the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex.
2. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 1, characterized in that, In the round ligament complex construction unit, an autologous tissue suspension system is constructed by the non-absorbable suture and the round ligament, and anchored to the iliopectineal ligament to repair midpelvic defects.
3. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 1, characterized in that, The system also includes a uterine unit: when the patient is uterus-preserving, the uterine position is identified, and the non-absorbable suture of the round ligament complex is continuously sutured to the anterior leaf of the round ligament and broad ligament on the same side until it reaches K centimeters to the side of the uterus, where K is a natural number greater than 0.5 centimeters. The avascular area of the posterior leaf of the broad ligament on the same side is identified, and the suture is passed through the avascular area of the posterior leaf of the broad ligament on the same side and sutured to the ipsilateral uterine-sacro ligament complex.
4. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 1, characterized in that, The system also includes a uterus-free unit: when the patient does not retain the uterus, after uterine removal, the location of the cardinal sacral ligament and vaginal stump is identified, and the cardinal sacral ligament and vaginal stump are sutured together with absorbable sutures to form a vaginal stump-cardinal sacral ligament complex. Then, the anterior leaf of the round ligament and broad ligament on the same side are continuously sutured together with non-absorbable sutures until they reach the side of the vaginal stump, and are sutured and fixed to the vaginal stump-cardinal sacral ligament complex on the same side.
5. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 3 or 4, characterized in that, The system also includes a pelvic peritoneum closure unit, identification of the pelvic floor peritoneum, and continuous suturing of the pelvic floor peritoneum with absorbable sutures.
6. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 1, characterized in that, The identification is performed by a trained object detection model to obtain the identification result. The object detection model includes any one or more of the following: Deformable DETR, Cascade R-CNN, Mask R-CNN, Swin-Transformer, YOLOX, PP-YOLO, YOLOv7, EfficientDet, CenterNet, and DETR.
7. The iliopubic ligament suspension system utilizing the round ligament complex according to claim 6, characterized in that, The training process of the target recognition model is as follows: acquire the laparoscopic image dataset and labels; input the laparoscopic image dataset and labels into the target detection model to be trained for training; compare the predicted labels of the target detection model with the real labels to calculate the loss function; iterate the model training until the loss function remains unchanged to obtain the trained target detection model; wherein the laparoscopic images and labels include any one or more of the following: the junction area of the round ligament and the lateral umbilical ligament, the external iliac vein, the iliopubic ligament, the broad ligament, the vesicouterine peritoneal reflection, the anterior leaf of the broad ligament, the posterior leaf of the broad ligament, the cardinal sacral ligament complex, the upper part of the cervix and vagina, the vaginal stump, the pelvic floor peritoneum, and the uterus.
8. A computer device comprising a memory, a processor, and a computer program or instructions stored in the memory, characterized in that, The computer program or instructions are executed by a processor to implement a method for iliopectine ligament suspension using the round ligament complex, including: Acquire real-time laparoscopic images of the patient; The region at the junction of the round ligament and the lateral umbilical ligament is identified based on the real-time images from the laparoscopy. The peritoneum is opened through the area where the round ligament and the lateral umbilical ligament meet, the loose tissue is separated, and the external iliac vein is identified. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; Non-absorbable sutures were sutured to the iliopubic ligaments on both sides as a backup; Identify the peritoneum through the broad ligament and open the peritoneum to the vesicouterine peritoneal reflection. Use spare non-absorbable sutures to continuously suture the contralateral round ligament and the anterior leaf of the broad ligament until they reach the side of the vaginal stump or the side of the uterus. Tighten the round ligament to obtain the round ligament complex.
9. An iliopubic ligament suspension device for the round ligament complex, comprising a memory, a processor, and a computer program or instructions stored in the memory, the computer program or instructions being controlled and executed by the processor, a suture device, non-absorbable sutures, a detection lens, tissue scissors, and peritoneal clamps, characterized in that, The suture device, suture suture, detection lens, tissue scissors, and peritoneal forceps are controlled by a computer program to perform the steps of iliopectine ligament suspension of the round ligament complex: Real-time laparoscopic images of the patient are acquired through the detection lens; The real-time laparoscopic images are used by a computer program to identify the area at the junction of the round ligament and the lateral umbilical ligament. The peritoneum at the junction of the round ligament and the lateral umbilical ligament is opened with tissue scissors and peritoneal forceps, loose tissue is separated, and the external iliac vein is identified by a detection lens and the computer program. The iliopubic ligaments on both sides are located based on the detection and localization of the area surrounding the external iliac vein; The suture device is combined with non-absorbable sutures, which are then sutured to the iliopubic ligaments on both sides as a backup. Based on the broad ligament, the peritoneum is identified by a computer program and opened by tissue scissors and peritoneal forceps until the computer program detects and identifies the vesicouterine peritoneal reflection. The contralateral round ligament and the anterior leaf of the broad ligament are continuously sutured with spare non-absorbable sutures until the computer program detects the side of the vaginal stump or the side of the uterus. The round ligament is then tightened to obtain the round ligament complex.
10. The iliopubic ligament suspension device for the round ligament complex according to claim 9, characterized in that, The process of iliopectine ligament suspension of the round ligament complex also includes hemostatic forceps, needle holders, and 100g forceps for clamping and controlling tissue, assisting in suturing, and vascular hemostasis; and a scalpel for separating tissue.