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2/22/2018 » 2/24/2018
AUGS Urogyn Update 2018

2/27/2018 » 3/3/2018
SUFU 2018 Winter Meeting

3/22/2018 » 3/24/2018
RCOG World Congress 2018, Singapore

Laparoscopic Sacralcolpopexy Tips and Tricks
Moderator(s): Amy Cassini
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Topics   Replies Score Author Latest Post
What do you think about combination... 2 I. Administrator Agree w/ Bruno.....this has been shown to have very high rate of infection and extrusion rates. Would not recommend.
by R. Moore
Friday, January 9, 2015
Approximately how many cm do you dissect... 2 I. Administrator We dissect approx. 4-5 cm down the anterior wall....ie about 1/2 way down and usually about 2/3 way down posterior wall. We do not attach mesh to the levators or the perineal body.
by R. Moore
Friday, January 9, 2015
Could you comment on patient positioning... 3 I. Administrator I agree w/ previous posts. We showed patient and surgeon/asst position on our slide. Arms tucked for patient, dorsal lithotomy position, adjustable allen stirrups with legs in neutral position protecting all nerves. We have experimented with different types of things to keep patient from sliding, ie egg crate taped to bed under patient, expensive things robotic companies have put out, shoulder sandbags etc and really haven't found one thing better than another. Steep trendelenberg is important though for exposure.
by R. Moore
Friday, January 9, 2015
What nedle type do you use for fixation at the sacral... 3 I. Administrator We try to avoid tackers. We have utilized a 2-0 ethibond on a SH needle for many years and have had no issues at all with placement of the needle, bleeding, or infection. I do think that Stephen's idea of the absorbatack is a good idea, especially in obese patients where visualization of the promontory is an issue, tack it first then fixate with a suture.
by R. Moore
Friday, January 9, 2015
What in your opinion are the main causes for... 3 I. Administrator I agree with Stephen and Bruno on this question. if it is early in their healing process, ie 3-6 months, I would recommend pelvic floor physical therapy as well and many times the discomfort will resolve with time and therapy. I have found the use of a lightweight mesh (ie < 25 g/m2) has reduced pain and dyspareunia significantly
by R. Moore
Friday, January 9, 2015
What do you advice to women who didnt finish the reproduction? 3 I. Administrator We would recommend a Laparoscopic Mesh Sacrohysteropexy. We have a video of this procedure listed on our website, www.miklosandmoore.com...under the video section. We don't wrap the mesh around the uterus, we place in posterior on the cervix and keep it only on the lower uterine segment if she is considering further pregnancy. we typically always complete a laparoscopic paravaginal repair at the time of the surgery to take care of the cystocele that is typically always present. We have had 3 full term pregnancies in patients following this procedure and they have all done well. (All had C/Sections for delivery of course).
by R. Moore
Friday, January 9, 2015
As you do not perform complete peritonisation... 3 I. Administrator We always close the peritneum as well....we don't always completely close it as the true goal of retroperitonealization of the mesh is to eliminate the opening on the right pelvic sidewall that a piece of bowel could go between the mesh and the right sidewall and therefore get obstructed in this loop or opening. In the video we presented there was only a small portion of mesh still exposed and we have not had any issue with bowel obstruction or bowel adhesions to this area causing problem if only a small portion is left exposed. Most of the time we do completely cover it with a running 2-0 monocryl suture that we run down, grab the bladder flap and then before running back up to the sacrum, you can backhand the needle and grab the posterior peritoneum by the rectum with a couple bites on the left side of the mesh (this can also be grabbed on the right side of the mesh prior to going up to the bladder flap) and then run it back up to the sacrum to tie it. Remember when colorectal surgeons complete a Ripstein procedure, they leave ALL the mesh exposed that is encircling the rectum.
by R. Moore
Friday, January 9, 2015
How much dose the vaginal lenght affect your destion? 3 I. Administrator Vaginal length does not really affect dissection....unless the vaginal length is extra long, ie greater than 10.5 or 11 cm, and in that case most likely the patient has an enterocele present apically and this must be addressed by placating the extra tissue (ie length) which can be done with interrupted 2-0 vicryl sutures horizontally, ie from the posterior apical rectovaginal septum to the apical portion of the pubocervical fascia. Alternatively the enterocele could be excised, however then you have to close the cuff and you then run the same risks of mesh extrusion as with TLH. We usually choose to just plicate and try to avoid excision. If you don't reduce the enterocele, the vaginal tissue can reach the sacrum by itself and therefore the mesh will NOT be placed down far enough on the vagina and it will only be on the enterocele and this will lead to higher rate of failure. Once the enterocele is reduced, the dissection can then be taken further down the anterior wall and the posterior wall, far enough to reach the good anterior and posterior fascia and therefore have a proper placement of the mesh. One must be careful if the vagina is too short, ie less than 7cm as once you place mesh over the apex there is no chance to elongate it and you will be stuck with that length...you may be able to gain a cm with sacralcolpopexy but with less than 7cm of vagina that may not be enough and you will then be stuck with a short vagina with mesh on the apex....very difficult to gain any length after that!
by R. Moore
Friday, January 9, 2015
Is the 30 degree camera necessary? 3 I. Administrator Robert Moore: We use only a 0 degree scope and have no issues getting posterior or anterior.
by R. Moore
Friday, January 9, 2015
What is your opinion about lateral... 1 I. Administrator i have no experience in this field the reference is JB DUBUISSON he works in Switzerland you can ask him BD
by Bruno DEVAL
Tuesday, December 23, 2014

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