Vault prolapse repair without use of mesh
by Jain Nutan

Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology

by Nutan Jain
About Video

This video presents a case of 56-year-old patient (ML: 35 years), present complaints: something coming out of vagina for last 8 years following total abdominal hysterectomy. Preoperative diagnosis: vault prolapse. Port placement: patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all 5 mm ports except camera port which is 10 mm. Surgical procedure: rectal probe and vaginal probe inserted. Foley’s catheter put in the bladder. Patient had a good overall muscle tone, uterosacral ligaments and levator ani as seen during surgery. At first a transverse incision given over the highest point of vaginal probe and bladder pushed down, posteriorly rectum pushed down and rectovaginal septum exposed. Now anteriorly pubocervical fascia is plicated by vicryl sutures and a firm buttressed platform is achieved. Then posteriorly, we start by taking bites in the levator muscles. Uterosacral ligaments are plicated. Posteriorly buttressing is continued by passing bites in the levators, rectovaginal septum, mid vagina and uterosacral ligaments. At the end, we find a very well supported vaginal vault. Cystoscopy done at the end of procedure and bilateral ureteric reflux is noted.

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