THE OPERATION OF CHOICE FOR VAGINAL VAULT SUSPENSION IN THE POST-MESH AGE;. A simpler and less complicated procedure than Sacral ...
LAPAROSCOPIC McCALL CULDOPEXY [extended] USING NON-ABSORBABLE ‘V-Loc’ SUTURES IN THE ‘EndoStitch’ device: THE OPERATION OF CHOICE FOR VAGINAL VAULT SUSPENSION IN THE POST-MESH AGE; A simpler and less complicated procedure than Sacral Colpopexy, with good results.
Roger Andrew McMaster-Fay, Clinical Lecturer, Central Clinical School, University of Sydney, Australia
AIM With the viability of mesh in gynaecological surgery in ever further doubt, this procedure and others like it, may well take over as the operation of choice, from the more complicated laparoscopic (or open) sacral colpopexy procedure.
INTRODUCTION I have been performing laparoscopic pelvic floor repairs in western Sydney since 2000. I have performed over 230 of these procedures. The higher rates of complications from the uterosacral colpopexy procedure were presented at AGES (2014 McMaster-Fay).
METHOD I use a similar technique to that described by C.Y.Liu (2005) except that the uterosacral ligaments and the Pouch of Douglas peritoneum are sutured together (McCall 1957) rather than plicated and the suturing is done with the EndoStitch (Covidien), using Polyester non-absorbable sutures. Since the non-absorbable V-Loc sutures have become available for the EndoStitch device, I have used them.
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1. Ureters are dissected from below thus mobilized from the Images can be placed here. repair. V-Loc nondissolving sutures secure upper uterosacral & lower cardinal ligaments with first bite, then is passed through its loop. 2. First suture repair complete. 3. Final suture of repair with POD almost completely obliterated. Peritoneum being sutured closed over drain. 4. Laparoscopic pelvic floor repair completed.
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RESULTS I have performed over 230 of these relatively simple procedures, with minimal complications from the repair. Adhesions from previous surgery can be difficult and this is where complications are more likely to occur. Since the non-absorbable V-Loc sutures on the EndoStitch device became available in mid-2013. I have used them and found them to be a further improvement to this technique. The V-Loc sutures allow for: a. Shorter operating time; b. Better control of suture tension; c. No knots which can erode through the vagina.
CONCLUSION With the viability of mesh in gynaecological surgery in ever further doubt, this procedure and others like this, may well take over, as the operation of choice, from the more complicated laparoscopic (or open) sacral colpopexy procedure. Certainly a randomised trial comparing the two procedures is indicated.
REFERENCES 1. 2. 1.
McMaster-Fay RA. 14 years of native tissue pelvic floor repair: a more simple procedure than sacral colpopexy. AGES PFS 2014 (SA). Lin LL, Phelps JY, Liu CY. Laparoscopic vaginal vault suspensions using uterosacral ligaments: a review of 133 cases. J Min Invasive Gynecol 2005; 12:216-20. McCall ML. Posterior culdeplasty. Obstet Gynecol 1957; 10:595.
