CN109498080A - A kind of operation separation bar, the U-shaped baffle of operation stitching and its application method - Google Patents

A kind of operation separation bar, the U-shaped baffle of operation stitching and its application method Download PDF

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Publication number
CN109498080A
CN109498080A CN201910005382.XA CN201910005382A CN109498080A CN 109498080 A CN109498080 A CN 109498080A CN 201910005382 A CN201910005382 A CN 201910005382A CN 109498080 A CN109498080 A CN 109498080A
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CN
China
Prior art keywords
section
pubis
separation bar
head section
shaped baffle
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
CN201910005382.XA
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Chinese (zh)
Inventor
陈德新
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Sichuan Provincial Hospital for Women and Children
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Sichuan Provincial Hospital for Women and Children
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Application filed by Sichuan Provincial Hospital for Women and Children filed Critical Sichuan Provincial Hospital for Women and Children
Priority to CN201910005382.XA priority Critical patent/CN109498080A/en
Publication of CN109498080A publication Critical patent/CN109498080A/en
Pending legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0801Prevention of accidental cutting or pricking
    • A61B2090/08021Prevention of accidental cutting or pricking of the patient or his organs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0815Implantable devices for insertion in between organs or other soft tissues

Abstract

The invention belongs to the field of medical instrument technology, disclose a kind of operation separation bar and the U-shaped baffle of operation stitching used in conjunction with, also disclose the application method of aforementioned two kinds of instruments.The advantage of the invention is that, operation separation bar provided by the invention can preferably separate the gap after pubis between bladder and push tissue passivity extruding open, not easy damaged bladder, blood vessel, the U-shaped baffle of operation stitching can preferably adapt to bladder body, convenient for blocking front end tissue, sufficiently fascia tissue after exposure pubis during operation on urethra.The application method of aforementioned two kinds of instruments provided by the invention, the fascia after vagina carries out pubis, cycling suturing forms " hammock " from left to right, treat female stress urinary incontinence, it is easy to operate, wound is small, the generation that is not necessarily to high consumptive material, and reduces visceral organ injury, hemotoncus, pain, mesh sheet related complication etc..

Description

A kind of operation separation bar, the U-shaped baffle of operation stitching and its application method
Technical field
The invention belongs to the field of medical instrument technology, and in particular to a kind of operation separation bar, the U-shaped baffle of operation stitching and its Application method.
Background technique
Pelvic floor dysfunction disease (pelvic floor dysfunction, PFD) mainly includes stress incontinence (stress urinary incontinence, SUI) and pelvic organ prolapse (pelvic organ prolapse, POP) is Very universal disease in women, disease incidence increase with the increase at age, have become global medicine and public have defended Raw problem.
Stress incontinence (SUI) is as a kind of non-lethal disease for seriously affecting patient work and daily life, hair Raw rate is 12.8%~46.0%.Chinese adult women SUI total prevalence rate is up to 18.9%, and in 50~59 years old age bracket, SUI suffered from Sick rate highest is 28.0%.
With stress incontinence dependency structure: pubourethral ligament (PUL) --- overhung construction;It is carried on the back originating from pubic symphysis The lower end in face, fan-shaped decline, intermediate portion is attached to mid-urethral, side and musculus pubococcygeus and vaginal wall adheres to, it Damage or defect be stress incontinence main cause occur.For the reparation of the institutional framework, main pressure in the world Property urinary incontinence Minimally Invasive Surgery with urethral slings band art (pubis rear path TVT art and closed pore path TVT-O art) and pubis after Cusparia Ligament suspension (Burch) is representative, is the standard art formula for handling SUI.Both operations are primarily present following defect:
Urethral slings band art surgical effect it is preferable, but its recent major complications be intraoperative hemorrhage, postoperative hematoma and Injury of bladder and urethra, long term complication have new urge incontinence and stress incontinence, dysuria, pain, mesh sheet It corrodes and exposes.The relevant complication of mesh sheet is clinically handled rather intractable at present;In addition, mesh sheet is high-quality consumptive material, generally It is 6000-10000 RMB that one operation, which needs consumptive material, and patient medical burden is very heavy.
Cooper's ligament suspension (Burch) is divided into through abdominal and through two kinds of approach of laparoscopic surgery after pubis, this two Although kind of operation is promoted slower in the presence of for a long time.Trans-abdominal operation wound is larger, and the more patient of postoperative complication restores Slowly;It is larger through laparoscopic surgery difficulty, it is not easy to grasp.
However, modern treatment idea is to abandon the outdated ideas of the tissue and organ of simple excision prolapsus, protrusion is minimally invasive, to the greatest extent Amount passes through perineum vagina and laparoscopic surgery;People-oriented, small notch, low-risk, low pain, low discomfort emphasize changing for symptom It is kind;According to national conditions, improvement or flexible art formula achieve the purpose that effective diagnosis and treatment, safe diagnosis and treatment and economic diagnosis and treatment.Based on this, apply People develops a kind of new operation method that can overcome drawbacks described above.
However, commonly performing the operation in operation at present, the general end of separation bar is sharper, and diameter is thinner, is integrally of a straight line type.By It is operated in new art formula Via vagina, needs to separate the tissue after pubis between bladder in surgical procedure, use is existing Operation separation bar is easy to damage bladder and blood vessel, and due to squeezing not enough surrounding tissue, can not push surrounding tissue open.This Outside, baffle is commonly sutured in operation at present and be generally flat design, be integrally of a straight line type.Since new art formula Via vagina carries out It operates, needs to organize to stop after pubis by bladder etc. in surgical procedure, sufficiently fascia tissue after exposure pubis, but current gear Plate can not reserve space appropriate for stitching since its fault of construction can not preferably stop the tissue such as bladder after pubis It closes, can not block surrounding tissue makes it not by needlestick injury, influences needle out.Aforementioned operation separation bar and suture baffle make entire hand Art progress is not smooth, greatly prolongs operating time, increases operation risk.Therefore, it is badly in need of developing a kind of to overcome drawbacks described above Separation bar of performing the operation and suture baffle.
Summary of the invention
In order to solve the above problems existing in the present technology, it is an object of that present invention to provide a kind of simple, few intercurrent disease and Economic operation separation bar, the U-shaped baffle of matching used operation stitching and its application method.
The technical scheme adopted by the invention is as follows:
The one end in a kind of operation separation bar, including head section, middle section and endpiece, one end of the endpiece and the middle section connects Connect, the other end in the middle section is connect with one end of the head section, the end of the head section relative to the head section one end by It gradually upwarps, the endpiece is flat.
Specifically, the outer surface of above-mentioned operation separation bar, the middle section and the junction of the head section be provided with it is cricoid Groove;The middle section and the cross section of head section are ellipse;The width of the widest part of head section is 1.0cm, the hand Art separation bar is made of metal material.
The present invention also provides a kind of U-shaped baffles of operation stitching being used cooperatively with aforementioned operation separation bar, including arc Section, active section and handling section;One end of the segmental arc is bent downwardly relative to the other end of the segmental arc;The curved portion The endpoint of one end be A, the endpoint of the other end of the curved portion is B, and the angle between the tangent line of the A and the tangent line of B is γ;The edge of one end of the segmental arc is arc;One end of the active section and the other end of segmental arc connect;The work The other end of section is connect with one end of the handling section, and the middle section of the active section is relative to the active section and the handling section Junction downward concave shape camber middle section.
Specifically, the above-mentioned U-shaped baffle of operation stitching, the segmental arc is U-shaped, including sequentially connected first arm, third Curved portion and the second arm, second arm are connect with the one end in the middle section, extended line of first arm to curved portion direction With the second arm to the angle of the extended line in curved portion direction be γ;The width of the U-shaped baffle of operation stitching is 2.0-2.5cm; The U-shaped baffle of operation stitching is made of metal material.
The present invention also provides the application method of a kind of aforementioned operation separation bar and the U-shaped baffle of operation stitching, including it is as follows Step:
(1) patient's lithotomy position, exposure vagina perineum, disinfection;
(2) injecting normal saline is fetched water pad under anterior vaginal wall mucous membrane and after pubis;
(3) vaginal wall mucous membrane is cut, vaginal wall is separated;Vaginal wall group after pubis is separated using aforementioned operation separation bar It knits;
(4) bladder is blocked using the U-shaped baffle of aforementioned operation stitching, is organized after exposure pubis, using No. 4 silk threads first from left side Fascia tissue after pubis is sewed after pubis from top to bottom, this tissue is more tough and tensile;Needle out uses operation stitching baffle exposure right side After pubis, fascia tissue after sewing pubis from the bottom up from right side again using the needlework, needle, forms a close ring out, intermediate It knots, forms hammock;Pay attention to the height (elasticity) of hammock;
(5) 3 needles are sutured repeatedly as described in step (4), needle is more into after pubis or inwardly earlier above for latter needle;
(6) stop blooding, suture vaginal wall, operation terminates.
The invention has the benefit that
Operation provided by the invention separation nose slightly point, flat can preferably separate the gap after pubis between bladder, And push tissue passivity extruding open, easy damaged bladder, blood vessel, front end and middle part do not have the U-shaped baffle of operation stitching of radian can Preferably to adapt to bladder body, convenient for blocking front end tissue, sufficiently fascia tissue after exposure pubis during operation on urethra. The application method of aforementioned two kinds of instruments provided by the invention, the fascia after vagina carries out pubis, from left to right cycling suturing shape Female stress urinary incontinence is treated at " hammock ", it is easy to operate, wound is small, is not necessarily to high consumptive material, and reduce visceral organ injury, blood The generation of swollen, pain, mesh sheet related complication etc..
Detailed description of the invention
Fig. 1 is the side view of operation separation bar of the invention;
Fig. 2 is the top view of operation separation bar of the invention;
Fig. 3 is the second head section transition part of operation separation bar of the invention to the connection schematic diagram of end;
Fig. 4 is the overall structure diagram of the U-shaped baffle of operation stitching of the invention;
Fig. 5 is the side schematic view of the U-shaped baffle of operation stitching of the invention;
Fig. 6 is the side schematic view of the segmental arc of the U-shaped baffle of operation stitching of the invention.
1- head section;11- the first head section transition part;12- the second head section transition part;13- third head section transition part;14- the 4th Head section transition part;The end 15-;The middle section 2-;21- groove;3- endpiece;The second curved portion of 31-;32- square plate;The first curved portion of 33-; 4- segmental arc;5- active section;6- handling section.
Specific embodiment
With reference to the accompanying drawing and specific embodiment does further explaination to the present invention.
As shown in Figure 1-3, operation separation bar structure provided by the invention is as follows:
The operation separation bar is made of metal material, including sequentially connected head section 1, middle section 2 and endpiece 3.Middle section 2 and head The cross section of section 1 is ellipse, and the outer surface of the two junction is provided with cricoid groove 21.Thickness (D) described hereinafter and Width (L) is subject to direction shown in Fig. 1.
As shown in Figures 3 and 4, the direction of one end along one end that head section 1 is connect with middle section 2 to head section 1 far from middle section 2, head The axis of section 1 gradually upwarps certain angle relative to the axis in middle section 2, and head section 1 includes sequentially connected first head section transition part 11, the second head section transition part 12, third head section transition part 13, the 4th head section transition part 14 and end 15.
As shown in figure 3, the width and thickness of the first head section transition part 11 is respectively L1 and D1, the second head section transition part 12 Width and thickness is respectively L2 and D2, and the width and thickness of third head section transition part 13 is respectively L3 and D3, the 4th head section transition The width and thickness in portion 14 is respectively L4 and D4, and the width and thickness of end 15 is respectively L5 and D5.Aforementioned thicknesses or width are equal It is respectively third head section transition part 13 and the 4th head section for the thickness or width of the structure and next structural attachments, such as L3 and D3 The width and thickness of the junction third head section transition part 13 of transition part 14.
Along the second head section transition part 12 and 11 junction of the first head section transition part to the second head section transition part 12 and third head Section transition part 13 junction direction, the thickness (D) of the cross section of the second head section transition part 12 gradually become smaller and width (L) by Gradual change is big (D2<D1, L2>L1);Along third head section transition part 13 and 12 junction of the second head section transition part to third head section transition The width in the direction in portion 13 and the junction of the 4th head section transition part 14, the cross section of third head section transition part 13 become larger and Thickness is constant (D3=D2, L3 > L2);Along the 4th head section transition part 14 and third head section transition part 13 junction to the 4th head section mistake The direction of the junction of portion 14 and end 15 is crossed, the width of the cross section of the 4th head section transition part 14 gradually becomes smaller and thickness is constant (D4=D3, L4 < L3);Along the direction of the end of end 15 and 14 junction of the 4th head section transition part to end 15, end 15 The width and thickness of cross section gradually becomes smaller (D5 < D4, L5 < L4).Generally speaking, the head section of the operation separation bar is slightly sharp, flat, Become narrow gradually from left to right it is thinning, it is mellow and full smooth, from the beginning toward wide, elder generation Bao Houhou after tail first point.Operation separation provided by the invention The head section of stick most wide (L3) is 1.0cm, what the head section that third head section transition part 13 and the 4th head section transition part 14 are formed smoothly was located Thickness (D3 or D4) is 0.5cm, which smoothly locates convenient for the gap after separation pubis between bladder and squeeze tissue passivity Pressure is pushed open, not easy damaged bladder, blood vessel.
As shown in Fig. 2, endpiece 3 is sequentially connected and is formed by the first curved portion 33, square plate 32 and the second curved portion 31;First arc The thickness of shape portion 33 and square plate 32 is respectively less than the thickness of the second curved portion 31 and the junction in middle section 2;First curved portion 33 and side The width of plate 32 is all larger than the width of the second curved portion 31 and the junction in middle section 2;Along the company of the second curved portion 31 and square plate 32 Meet place to the direction of the second curved portion 31 and the junction in middle section 2, the thickness of the second curved portion 31 be gradually increased and width gradually Become smaller, the second curved portion 31 and the second curved portion 31 of the junction in middle section 2 and the cross section in middle section 2 etc. are big.
As Figure 4-Figure 6, the invention also discloses a kind of with the U-shaped baffle of operation stitching that is used cooperatively of operation separation bar, The U-shaped baffle of the operation stitching is made of metal material, width 2.0-2.5cm, including segmental arc 4, active section 5 and handling section 6; As shown in figure 4, one end of segmental arc 4 is bent downwardly relative to the other end of segmental arc 4;The endpoint of one end of segmental arc 4 is A, The endpoint of the other end of segmental arc 4 is B, and the angle between the tangent line of A and the tangent line of B is γ, and γ is less than or equal to 90 °;Segmental arc 4 One end edge be arc;Preferably, segmental arc 4 is U-shaped, including sequentially connected first arm, third curved portion and second Arm, the second arm are connect with the one end in middle section 2.
The invention also discloses the application method of aforementioned two kinds of medical instruments, i.e., a kind of Via vagina mid-urethral linear suspension Art (healthcare hospital for women & children, Sichuan Province art formula), includes the following steps:
(1) patient's lithotomy position, exposure vagina perineum, disinfection;
(2) injecting normal saline is fetched water pad under anterior vaginal wall mucous membrane and after pubis;
(3) vaginal wall mucous membrane is cut, vaginal wall is separated;Using operation separation bar provided by the invention separation vaginal wall until It is organized after pubis;
(4) bladder is blocked using the U-shaped baffle of operation stitching provided by the invention, is organized after exposure pubis, uses No. 4 silk threads First sew fascia tissue after pubis from top to bottom after the pubis of left side, this tissue is more tough and tensile;Needle out uses operation stitching baffle After the pubis of exposure right side, fascia tissue after sewing pubis from the bottom up from right side again using the needlework, needle out.Form a closure Ring, centre knot, and form hammock;Pay attention to the height (elasticity) of hammock;
(5) 3 needles are sutured repeatedly, needle is more into after pubis or inwardly earlier above for latter needle;
(6) stop blooding, suture vaginal wall, operation terminates.
The advantages of aforementioned application method (Via vagina mid-urethral linear suspension art (healthcare hospital for women & children, Sichuan Province art formula)), exists In:
One, the operation principle is mature, forms hammock in mid-urethral, is internationally recognized theory to control the urinary incontinence.But Be at present in the world, no doctor take by vagina carry out pubis after fascia suture to be formed " hammock " treatment female stress urine The report of incontinence, method provided by the invention are for the first time.
Two, the operation method is compared with existing operation method;
1. operation method is obviously simple, Via vagina operation is ob-gyn's indispensability surgical skills, is performed the operation with urethral canal hanging strip (pubis rear path TVT art and closed pore path TVT-O art) and abdominal, laparoscope (cooper's ligament suspension after pubis (Burch)) it compares, this operation is simple, is easy to learning manipulation, is convenient for in all parts of the country and other parts of the world Rapid Popularization.
2. safety, using common silk thread, Via vagina sutures fascia after the pubis of two sides using No. 4 silk threads in parallel, and centre knots, Form " hammock " in mid-urethral, suture firmly hang over formd on fascia after pubis one artificial " pubourethral ligament " or " hammock " treats female stress urinary incontinence.Since without important organ, big blood vessel etc., the surgical procedure is simple, complication It is few, the internal organs risk such as no big bleeding, damage bladder;In addition, the erosion complication that mesh sheet, suspender belt generate is current global medical matters people Member's more stubborn problem, operation does not use mesh sheet, suspender belt, so without the generation of such complication.
3. economical, mesh sheet, suspender belt are high-quality medical treatment consumptive materials at present, and medical control department strict control mitigates common people Medical expense has been national main trend, which does not need the high-quality medical treatment consumption such as the high end equipments such as laparoscope, mesh sheet and suspender belt Material, only with common silk suture, a patient can save 6000-10000 yuans of high-quality consumptive material, China every year there are about 50000 patient with operation will save 300,000,000-5 hundred million RMB for country and patient.
4. good operation effect, success rate of operation, cure rate at a specified future date are more obvious than other operations high.
The present invention is not limited to above-mentioned optional embodiment, anyone can show that other are each under the inspiration of the present invention The product of kind form.Above-mentioned specific embodiment should not be understood the limitation of pairs of protection scope of the present invention, protection of the invention Range should be subject to be defined in claims, and specification can be used for interpreting the claims.

Claims (5)

1. a kind of operation separation bar, it is characterised in that: including head section (1), middle section (2) and endpiece (3), the one of the endpiece (3) End is connect with the one end of the middle section (2), and the other end of the middle section (2) is connect with one end of the head section (1), the head section (1) end is gradually upwarped relative to one end of the head section (1), and the endpiece (3) is flat.
2. operation separation bar according to claim 1, it is characterised in that: the junction of the middle section (2) and head section (1) Outer surface is provided with cricoid groove (21);The cross section of the middle section (2) and head section (1) is ellipse;The head section (1) The width of widest part is 1.0cm, and the operation separation bar is made of metal material.
3. a kind of U-shaped baffle of operation stitching being used cooperatively with operation separation bar as claimed in claim 1 or 2, it is characterised in that: packet Bracket section (4), active section (5) and handling section (6);One end of the segmental arc (4) is relative to the another of the segmental arc (4) End is bent downwardly;The endpoint of one end of the curved portion (4) is A, and the endpoint of the other end of the curved portion (4) is B, the A Tangent line and B tangent line between angle be γ;The edge of one end of the segmental arc (4) is arc;The active section (5) One end is connect with the other end of segmental arc (4);The other end of the active section (5) is connect with one end of the handling section (6), institute It states in the downward concave shape camber in junction of the middle section of active section (5) relative to the active section (5) and the handling section (6) Section.
4. the U-shaped baffle of operation stitching according to claim 3, it is characterised in that: the segmental arc (4) is U-shaped including suitable The first arm, third curved portion and the second arm of secondary connection, second arm are connect with the one end of the middle section (5), and described first Extended line from arm to curved portion direction and the second arm to the angle of the extended line in curved portion direction be γ;The operation stitching is U-shaped The width of baffle is 2.0-2.5cm;The operation separation bar is made of metal material.
5. a kind of application method of perform the operation separation bar and the U-shaped baffle of operation stitching, which comprises the steps of:
(1) patient's lithotomy position, exposure vagina perineum, disinfection;
(2) injecting normal saline is fetched water pad under anterior vaginal wall mucous membrane and after pubis;
(3) vaginal wall mucous membrane is cut, vaginal wall is separated;It is straight using the separation vaginal wall of operation separation bar described in as claimed in claim 1 or 22 It is organized after to pubis;
(4) bladder is blocked using the U-shaped baffle of operation stitching described in claim 3 or 4, is organized after exposure pubis, uses No. 4 silks Line first sews fascia tissue after pubis from top to bottom after the pubis of left side, this tissue is more tough and tensile;Needle out is kept off using operation stitching After the pubis of plate exposure right side, fascia tissue after sewing pubis from the bottom up from right side again using needlework, needle, forms a closure out Ring, centre knot, and form hammock;Pay attention to the height of hammock;
(5) 3 needles are sutured repeatedly as described in step (4), needle is more into after pubis or inwardly earlier above for latter needle;
(6) stop blooding, suture vaginal wall, operation terminates.
CN201910005382.XA 2019-01-03 2019-01-03 A kind of operation separation bar, the U-shaped baffle of operation stitching and its application method Pending CN109498080A (en)

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CN201910005382.XA CN109498080A (en) 2019-01-03 2019-01-03 A kind of operation separation bar, the U-shaped baffle of operation stitching and its application method

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN2693179Y (en) * 2004-04-07 2005-04-20 步召德 Pelvic cavity showing apparatus for rectum operation
CN102548502A (en) * 2009-05-28 2012-07-04 康特恩公司 Correction of stress urinary incontinence
US8287535B2 (en) * 2005-05-11 2012-10-16 Mayo Foundation For Medical Education And Research Apparatus and methods for internal surgical procedures
CN203226852U (en) * 2013-02-08 2013-10-09 西安市第四医院 Vagina baffle plate
CN108524059A (en) * 2018-05-03 2018-09-14 上海市第妇婴保健院 The sling operation method and device of ligamentum inguinale treats pelvic organ prolapse in front of ligamentum teres to anterior superior spine

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN2693179Y (en) * 2004-04-07 2005-04-20 步召德 Pelvic cavity showing apparatus for rectum operation
US8287535B2 (en) * 2005-05-11 2012-10-16 Mayo Foundation For Medical Education And Research Apparatus and methods for internal surgical procedures
CN102548502A (en) * 2009-05-28 2012-07-04 康特恩公司 Correction of stress urinary incontinence
CN203226852U (en) * 2013-02-08 2013-10-09 西安市第四医院 Vagina baffle plate
CN108524059A (en) * 2018-05-03 2018-09-14 上海市第妇婴保健院 The sling operation method and device of ligamentum inguinale treats pelvic organ prolapse in front of ligamentum teres to anterior superior spine

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