ENDO STITCH

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ENDO STITCH. Laparoscopic pelvic floor repair using the Endo-Stitch : a series of 108 cases over 6 years Roger A. McMaster-Fay Department of Obstetrics and Gynaecology, University of Sydney, Westmead & Penrith. LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION. 1. Ureteric Dissection. - PowerPoint PPT Presentation

Text of ENDO STITCH

  • ENDO STITCH

  • Laparoscopic pelvic floor repair using the Endo-Stitch:a series of 108 cases over 6 years

    Roger A. McMaster-FayDepartment of Obstetrics and Gynaecology, University of Sydney, Westmead & Penrith.

  • LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION1. Ureteric Dissection

  • LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION2. Suture Placement

  • LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION3. Tying the Knot

  • LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION4. Suturing the Layers:Uterosacral ligaments &Paracolic tissues

  • LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION5. Case Presentation

  • With the advent of the Endo-Stitch (United States Surgical Corporation, a division of the Tyco Healthcare Group LP) in the late 1990s, endoscopic surgeons have been able to perform suturing and intra-corporeal knot tying with this ingenious device. Endoscopic upper-abdominal surgeons have been using this device with SurgiDac (Dacron) sutures to perform Nissen Fundoplications for hiatus hernia and reflux.

    In 1999 I performed my first laparoscopic pelvic floor repair using this device. I perform a McCall type culdoplasty similar to the technique described by CY Liu (2005)1, dissecting and mobilizing the ureters from below. Liu uses Gore-Tex sutures as opposed to a suturing device. I have now performed 108 procedures with none requiring conversion to either abdominal or vaginal procedure. Two thirds were performed with laparoscopic hysterectomy. There were no direct ureteric or large bowel injuries or obstructions and one inadvertent cystotomy.

  • Originally I did not obliterate the enterocele sac as was the recommendation of Harry Reich (1999)2. Subsequently a patient required a laparotomy and bowel resection for obstruction secondary to incarceration in the enterocele sac a few months after the original surgery. Now I include large bites of the para-rectal tissues below the uterosacral ligaments and incorporate them into the repair. I believe these add important support to the repair.

    One patient early in the series required a vaginal repair of rectocele three months after the original procedure. One patient developed a port site herniation of small bowel requiring an open reduction three days after original surgery (no bowel resection required). Two patients have required a repeat procedure that I will describe in detail.

  • Thank youPelvic floor repairs for vaginal vault prolapse can be adequately performed laparoscopically using the Endo-Stitch device.

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