| Autor: |
Gaddam, NG, Marantidis, J, Richter, LA, Gutman, RE |
| Zdroj: |
Journal of Minimally Invasive Gynecology; 2024 Supplement, Vol. 31 Issue 11, pS59-S60, 2p |
| Abstrakt: |
To illustrate surgical techniques for vaginal attachment of polypropylene mesh during laparoscopic sacrocolpopexy including approaches to optimize dissection in the vesicovaginal and rectovaginal spaces. Surgical video with case report. Operating room within an academic hospital. The patient was a 64-year-old G3P3 female with bothersome bulge symptoms in setting of stage III uterovaginal prolapse. She had no bothersome urinary symptoms and pre-operative urodynamics showed normal voiding function without detrusor overactivity or occult stress urinary incontinence. After counseling on her options for management, she elected to proceed with surgical management. The patient underwent total vaginal hysterectomy with bilateral salpingectomy, laparoscopic sacrocolpopexy, anterior/posterior repair, and cystourethroscopy. Surgical techniques specific to vaginal mesh attachment following hysterectomy are reviewed in this video. Following total vaginal hysterectomy, Allis clamps, blunt dissection, and sharp dissection are used to enter the vesicovaginal and rectovaginal spaces. Off the field, the polypropylene "L" mesh is cut in half to create two separate arms. The anterior and posterior arms are attached to the anterior and posterior vaginal walls respectively using two rows of 2-0 PDS interrupted stitches to evenly distribute the force of the attached mesh across the vaginal wall. Care is taken to remain at least 1-2 cm from the vaginal cuff edge to prevent inclusion of the mesh into the cuff closure. Vaginal mesh attachment provides several advantages by decreasing operative time through reduction in laparoscopic suturing, providing an easier and safer approach for distal graft placement, allowing differential tensioning of the anterior and posterior vaginal walls, and shortening of the vaginal walls when indicated. [ABSTRACT FROM AUTHOR] |
| Databáze: |
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