Colpocleisis techniques: an open-and-shut case for advanced pelvic organ prolapse

Abstract

The purpose of this video is to demonstrate several advanced surgical techniques to improve efficiency and optimize the clinical success of the colpocleisis procedure. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population. For women with advanced pelvic organ prolapse, multiple medical comorbidities, and who no longer desire penetrative vaginal intercourse, an obliterative approach is preferred due to decreased anesthetic needs and operative time, and 95% long-term efficacy. The umbrella term of “colpocleisis” encompasses LeFort Colpocleisis, a uterine sparing procedure, colpocleisis with hysterectomy, and post-hysterectomy vaginal vault colpocleisis. Typically levator myorrhaphy and perineorrhaphy are also included to reinforce the repair. This video demonstrates several advanced surgical techniques to streamline the colpocleisis procedure. These methods include using electrosurgery to mark out the epithelium, the push-spread technique for superficial dissection, and demonstrating methods to create the lateral tunnels during LeFort colpocleisis with and without the use of a urinary catheter. Retraction with Allis clamps and rubber bands on hemostat clamps are utilized to improve visualization. Approximation of the anterior and posterior vaginal muscularis is also performed to obliterate the vaginal canal. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. An anatomic model is used to demonstrate the suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles. Ultimately the goal of colpocleisis is a vaginal opening that is one centimeter in width and three centimeters in depth. These skills enable the surgeon to maximize efficiency and surgical outcomes of obliterative procedures for advanced stage pelvic organ prolapse.