Sybil G Dessie1,2,3, Peter L Rosenblatt4,5. 1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA. sdessie@mah.harvard.edu. 2. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. sdessie@mah.harvard.edu. 3. Department of Obstetrics and Gynecology, Mount Auburn Hospital, 725 Concord Avenue, Suite 1200, Cambridge, MA, 02138, USA. sdessie@mah.harvard.edu. 4. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. 5. Department of Obstetrics and Gynecology, Mount Auburn Hospital, 725 Concord Avenue, Suite 1200, Cambridge, MA, 02138, USA.
Abstract
INTRODUCTION: The objective was to describe a novel method for maintaining bilateral channel patency for potential uterine drainage during LeFort colpocleisis. METHODS: This video presents a novel approach for ensuring bilateral channel patency during colpocleisis. An 88-year-old gravida 2 para 2 with stage 4 uterovaginal prolapse presented for definitive surgical management. She was no longer sexually active. After counseling on various treatment options, she elected to proceed with a LeFort colpocleisis. During the procedure, the vaginal epithelium is dissected off the underlying tissue with sharp dissection after infiltration with local anesthetic. After the epithelium is removed anteriorly and posteriorly, a blue vessel loop is placed across the cervix and within the lateral channels as they are created with a series of figure of eight stitches. Care is taken to suture around and not through the vessel loop. This is done on both sides. The anterior and posterior dissected surfaces of the vagina are then reapproximated to involute the vagina until the distal epithelial edges can be brought together. Once the vaginal epithelial edges are sewn, the vessel loop is easily pulled through, ensuring channel patency. CONCLUSIONS: The vessel loop technique demonstrated in this video allows the surgeon to ensure that the bilateral channels remain patent throughout the procedure.
INTRODUCTION: The objective was to describe a novel method for maintaining bilateral channel patency for potential uterine drainage during LeFort colpocleisis. METHODS: This video presents a novel approach for ensuring bilateral channel patency during colpocleisis. An 88-year-old gravida 2 para 2 with stage 4 uterovaginal prolapse presented for definitive surgical management. She was no longer sexually active. After counseling on various treatment options, she elected to proceed with a LeFort colpocleisis. During the procedure, the vaginal epithelium is dissected off the underlying tissue with sharp dissection after infiltration with local anesthetic. After the epithelium is removed anteriorly and posteriorly, a blue vessel loop is placed across the cervix and within the lateral channels as they are created with a series of figure of eight stitches. Care is taken to suture around and not through the vessel loop. This is done on both sides. The anterior and posterior dissected surfaces of the vagina are then reapproximated to involute the vagina until the distal epithelial edges can be brought together. Once the vaginal epithelial edges are sewn, the vessel loop is easily pulled through, ensuring channel patency. CONCLUSIONS: The vessel loop technique demonstrated in this video allows the surgeon to ensure that the bilateral channels remain patent throughout the procedure.
Keywords:
Colpocleisis; Pelvic organ prolapse; Surgery
Authors: M P Fitzgerald; H E Richter; C S Bradley; W Ye; A C Visco; G W Cundiff; H M Zyczynski; P Fine; A M Weber Journal: Int Urogynecol J Pelvic Floor Dysfunct Date: 2008-08-09