International urogynecology journal · 2020
Video of uterovaginal procidentia repair incorporating a high extraperitoneal uterosacral vault suspension.
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Zilberlicht Ariel, Dwyer Peter L, Rajamaheswari Natarajan, Dykes Nicola, Karmakar Debjyoti
Аннотация
INTRODUCTION AND HYPOTHESIS: Women with high-grade uterovaginal prolapse have a higher incidence of levator injury, larger levator hiatal defects, and are at a greater risk of recurrent prolapse after pelvic organ prolapse (POP) surgery. RCOG guidelines have recommended prophylactic sacrospinous suspension at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. The aim of the video is to describe our surgical approach at the time of surgery for advanced POP, and describe the technique for modified McCall high extraperitoneal vault suspension.
METHODS: We have modified the McCall culdoplasty by extending the dissection of the middle portion of the uterosacral/cardinal ligaments so that the sutures can be placed higher and more laterally extraperitoneally to re-support the vaginal cuff at the time of a vaginal hysterectomy.
RESULTS: The video highlights the surgical technique used for apical support at the time of surgery for advanced POP.
CONCLUSIONS: This video demonstrates our modified McCall technique for vault suspension at the time of vaginal surgery for advanced POP. This technique could be considered an alternative technique to other modes of apical support.
METHODS: We have modified the McCall culdoplasty by extending the dissection of the middle portion of the uterosacral/cardinal ligaments so that the sutures can be placed higher and more laterally extraperitoneally to re-support the vaginal cuff at the time of a vaginal hysterectomy.
RESULTS: The video highlights the surgical technique used for apical support at the time of surgery for advanced POP.
CONCLUSIONS: This video demonstrates our modified McCall technique for vault suspension at the time of vaginal surgery for advanced POP. This technique could be considered an alternative technique to other modes of apical support.