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Minimally Invasive Surgery

Minimally Invasive Procedures

Pelvic Prolapse and Laparoscopic Enterocele and Cystocele Repair

Pelvic Prolapse is when pelvic supporting tissues weaken and fall down. The traditional approach to this problem has been vaginal surgery where the vaginal walls are opened and the supporting tissues (fascia) are sewn together with absorbable sutures. Pelvic prolapse can also be managed by laparoscopy. Through a laparoscope the space between the bladder and pubic bone is opened and using permanent suture the fascia is reattached to the pelvic sidewall. The upper end of the fascia may also be pulled up and reattached to the uterosacral ligaments. This provides a long-term, and anatomically correct, repair of cystoceles.

When a woman has her uterus, then all the supporting tissues attach around the cervix. When a woman has had her uterus removed, then the supporting tissues (fascia) from between the bladder and the vagina (pubocervical fascia) should come together with the supporting tissues between the rectum and the vagina (rectovaginal septum) at the top of the vagina, and these supports should also be attached to the uterosacral ligaments. We know that enteroceles (top of the vagina falling down) are due to the absence of supporting tissues (fascia) at the top of the vagina. Using the laparoscope these spaces are opened and using permanent sutures, with or without mesh, the pelvic supports are reconstructed. This provides a more definitive, longer lasting, and anatomically correct repair of enteroceles and vaginal vault prolapse.

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