Objective
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.
1
,2
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.
3
Additionally, colpocleisis is associated with a greater than 95% long-term efficacy
with low patient regret, high satisfaction, and improved body image.
- Fitzgerald MP
- Richter HE
- Bradley CS
- et al.
Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis.
Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1603-1609https://doi.org/10.1007/s00192-008-0696-6
4
,5
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.
Results
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.
Conclusion
The skills demonstrated enable the surgeon to maximize efficiency and surgical outcomes
for an effective obliterative procedure for advanced stage pelvic organ prolapse.
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References
- Prevalence of symptomatic pelvic floor disorders in US women.JAMA. 2008; 300: 1311-1316
- Prevalence and trends of symptomatic pelvic floor disorders in U.S. women.Obstet Gynecol. 2014; 123: 141-148
- Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1603-1609https://doi.org/10.1007/s00192-008-0696-6
- Body image, regret, and satisfaction following colpocleisis.Am J Obstet Gynecol. 2013; 209: 473.e1-473.e7https://doi.org/10.1016/j.ajog.2013.05.019
- Pelvic symptoms, body image, and regret after LeFort colpocleisis: a long-term follow-up.J Minim Invasive Gynecol. 2017; 24: 415-419https://doi.org/10.1016/j.jmig.2016.12.015
Article info
Publication history
Published online: March 23, 2023
Accepted:
March 7,
2023
Received:
January 10,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc.
