Division of Urogynecology, Walter Reed National Military Medical Center, Bethesda, MD.
Division of Urogynecology, Walter Reed National Military Medical Center, Bethesda, MD.
Urology. 2023 Jun;176:252. doi: 10.1016/j.urology.2023.03.011. Epub 2023 Mar 24.
To highlight several advanced surgical techniques for all types of colpocleisis. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population. Particularly for women with advanced pelvic organ prolapse who no longer desire penetrative vaginal intercourse and with multiple medical comorbidities, the obliterative approach is preferred due to decreased anesthetic needs, operative time, and perioperative morbidity. Additionally, colpocleisis is associated with a greater than 95% long-term efficacy with low patient regret, high satisfaction, and improved body image. MATERIALS AND METHODS: The umbrella term of "colpocleisis" encompasses a uterine-sparing procedure, the LeFort colpocleisis, colpocleisis with hysterectomy, and posthysterectomy vaginal vault colpocleisis. We demonstrate the surgical steps of performing each type of colpocleisis as well as levator myorrhaphy and perineorrhaphy, which are typically included to reinforce the repair.
To streamline the LeFort colpocleisis procedure, we demonstrate use of electrosurgery to mark out the epithelium and methods to create the lateral tunnels with LeFort colpocleisis with and without the use of a urinary catheter. We also present techniques that can be utilized across all types of colpocleisis including the push-spread technique for dissection, tissue retraction with Allis clamps and rubber bands on hemostat clamps to improve visualization, and approximation of the anterior and posterior vaginal muscularis to close existing space. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. We use an anatomic model to demonstrate appropriate suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles in order to adequately narrow the vaginal opening. Ultimately the goal of the colpocleisis procedure is a well-approximated, obliterated vagina, approximately 3 cm in depth and 1 cm in width.
The skills demonstrated enable the surgeon to maximize efficiency and surgical outcomes for an effective obliterative procedure for advanced stage pelvic organ prolapse.
强调各种类型的阴道封闭术的几种先进的手术技术。盆腔器官脱垂是一种常见的疾病，影响多达 40%的绝经后女性。对于那些不再希望进行阴道性交且患有多种合并症的晚期盆腔器官脱垂患者，由于麻醉需求、手术时间和围手术期发病率降低，闭塞方法是首选。此外，阴道封闭术与 95%以上的长期疗效相关，患者后悔率低、满意度高、身体形象改善。
“阴道封闭术”这一总称包括一种子宫保留手术，即勒福特阴道封闭术，子宫切除术后阴道穹窿阴道封闭术和阴道穹窿阴道封闭术。我们展示了每种阴道封闭术的手术步骤，以及提肌修补术和会阴修补术，这些通常包括在内以加强修复。
为了简化勒福特阴道封闭术的程序，我们展示了使用电外科标记上皮的方法以及使用和不使用导尿管创建侧隧道的方法。我们还介绍了可用于所有类型的阴道封闭术的技术，包括用于解剖的推展技术、使用 Allis 夹和止血夹上的橡皮筋进行组织牵拉以改善可视化，以及前、后阴道肌层的接近以闭合现有空间。必须注意不要超过尿道膀胱交界处的水平，以避免尿道成角。我们使用解剖模型演示提肌修补术中适当的缝线放置，以促进提肛肌的充分固定，从而充分缩小阴道开口。阴道封闭术的最终目标是形成一个紧密贴合的、封闭的阴道，深度约 3 厘米，宽度约 1 厘米。
所展示的技能使外科医生能够最大限度地提高手术效率和手术结果，以实现晚期盆腔器官脱垂的有效闭塞手术。
