Vaginal Closure Research Articles

Transumbilical Laparoendoscopic Single-Site Radical Hysterectomy without Uterine Manipulator and with Vaginal Closure

Study Objective Minimally invasive surgery (MIS) of radical hysterectomy (RH) was reported with inferior oncologic outcomes according to the New England Journal of Medicine (NEJM). Then some studies suggested that the no-touch technique may be a useful procedure to prevent tumor spillage as well as improve survival, and the procedures were improved continuously. Therefore, we performed RH targeting early-stage cervical cancer through laparoendoscopic single-site (LESS) approach with enclosed colpotomy and without uterine manipulator. Design A presentation of the surgery through this technical video. Setting A Hospital. Patients or Participants A 48-year-old postmenopausal woman was diagnosed as cervical cancer with stage IB1(FIGO 2018). Interventions After fully informed of the benefits and risks of different surgical approaches (open laparotomy and MIS), she agreed with the MIS. Measurements and Main Results The type C radical hysterectomy via LESS approach was performed successfully, the final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered fast and well with slight pain, and the incision scar was hidden perfectly for cosmetic purpose. Conclusion This video demonstrated that LESS-RH with vaginal closure and without manipulator was feasible and safe. Suspension skills played a significant role in the LESS-RH. Besides, this surgery procedure also involved 4 specific techniques to prevent tumor spillage, including creation of a vaginal cuff, avoidance of interoperate uterine manipulator, standard extent and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption, for reducing the increased risk of recurrence. However, further verifications were still required.

Laparoscopic Radical Hysterectomy with Enclosed Colpotomy Using Surgical Stapler for Early-Stage Cervical Cancer

Study Objective To report the application of Ethicon Endo-Surgery re-usable linear cutter (Ethicon endocutter) in vaginal closure without usage of uterine manipulator to prevent tumor spillage in laparoscopic radical hysterectomy for early-stage cervical cancer. Design A step-by-step explanation of the procedures using a video. Setting Hospital for women's health teaching and research. Patients or Participants This is a 41-year-old woman with clinical stage IBI cervical squamous cell cancer. Interventions After the contraindication was removed, laparoscopic type C radical hysterectomy with pelvic lymph node dissection and ovarian transposition were performed, the surgery was finished without usage of uterine manipulator. The patient signed an informed consent that allows us to use her clinical data. Measurements and Main Results In this method, after completion of the radical hysterectomy procedures, an Ethicon endocutter was placed into abdominal cavity through a 12-mm trocar. The uterus was elevated with fixed sutures on the uterus. Then, the stapler was placed. Before the surgical stapler was fired to close the vagina, we should checked that no other unintended structure was included in the jaws of the stapler. After being fired, the stapler places 2 triple-staggered rows of titanium staples and simultaneously knife blade cuts between them. Once the vagina has been divided, the stapler was released. The upper part of the vaginal cuff was excised and checked by pathology as a surgical margin, and the uterus was removed through the vagina. Finally, the vaginal cuff was closed with absorbable barbed sutures. Conclusion Vaginal closure with Ethicon endocutter before colpotomy is a useful and effective procedure to block vaginal cuff and prevent tumor spillage during laparoscopic radical hysterectomy of cervical cancer.

A Phase II Study on the Safety of Minimally Invasive Surgery Using Endoscopic Stapler to Prevent Tumor Spillage in Cervical Cancer

Study Objective The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that patients treated with minimally invasive surgery (MIS) techniques resulted in poorer outcomes than those treated with laparotomic techniques. In order to overturn the suggestion that MIS is inferior to laparotomic techniques, we designed and are now performing a phase II study on the safety of laparoscopic or robotic radical surgery using endoscopic stapler for inhibiting tumor spillage of cervical neoplasms (SOLUTION trial). Design A 42-year-old patient with cervical cancer clinical stage IB3 underwent robotic radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic sentinel lymphadenectomy with additional steps to improve surgical and morbidity outcomes. Setting In a Trendelenburg position, the patient is placed under general anesthesia. Patients or Participants This study is a prospective, multi-center phase II trial recruiting patients with early-stage cervical cancer. Interventions Key points of the operation are as follows: First, we perform tubal ligation and vaginal tube insertion, and then intracorporeal colpotomy using an endoscopic stapler to prevent tumor spillage into the peritoneal cavity. Second, we resected the stapled vaginal stump to retrieve the tumor specimen, and then close the vaginal stump again with continuous suture. Finally, we perform washing cytology three times: after trocar site insertion, intracorporeal colpotomy, and vaginal stump closure to check tumor spillage. Measurements and Main Results Ten patients so far have been enrolled in this study and all have received this surgery successfully without positive washing cytology, indicating no tumor spillage during the surgery. We plan to enroll a total of 120 patients within three years. Conclusion This is a feasible study design that can be performed with MIS, which is why it is valuable to prove its efficacy and safety through a phase II trial in order to overcome the limitations of MIS suggested in LACC trial. (SOLUTION ClinicalTrials.gov number, NCT04370496)

Dr. Yakov Rosenthal. Przypadok utworzenia sie kamienia w jamie pecherzowo-pochwowej po zupelnem zaszyciu przewodu pochwowego. (Colpokleisis). (Gazeta lekarska, No. 12, 1894). A case of the formation of a stone in the vesicovaginal cavity after the operation of the complete obliteration of the sleeve

In 42 years old, extremely emaciated, sick, 20 years ago, one who was giving birth, developed a vesicovaginal fistula during childbirth. Repeatedly perfect operations on this occasion did not bring relief to the patient, until, 5 years ago, she agreed to an operation of artificial vaginal closure (colpokleisis). A year and a half ago, the patient began to feel pain in the lower abdomen, which intensified in the last time to intolerance, in addition, there was an involuntary discharge of urine.

SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

BackgroundMinimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study...

Protective Maneuver to Avoid Tumor Spillage during Laparoscopic Radical Hysterectomy: Vaginal Cuff Closure

To demonstrate the feasibility of a protective maneuver to avoid tumor exposure during laparoscopic radical hysterectomy. This video illustrates the vaginal cuff closure technique in cervical cancer surgery. The Oncologic Gynecology Department at the University Hospital La Fe. After the Laparoscopic Approach to Cervical Cancer trial [1], the laparoscopic approach to the surgical treatment of cervical cancer has been questioned: laparotomic surgery has been associated with a better cancer outcome. This publication has changed the current approach recommendation for performing radical hysterectomy from minimally invasive surgery to open surgery. There are some theories that might justify these findings. In minimally invasive surgery, the use of a uterine manipulator can condition the spread owing to erosion and friction caused on the tumor, even leading to the perforation of the tumor. In addition, intraperitoneal colpotomy can lead to pelvic peritoneum contamination by the tumor. To close the gap between laparoscopy and laparotomy, some protective maneuvers, such as vaginal cuff closure, have been proposed [2,3]. These strategies aim to reduce the possibility of manipulation or exposure of the tumor to the pelvis during colpotomy in laparoscopic radical hysterectomy. These protective maneuvers have been shown to decrease the relapse rate in retrospective studies [4]. However, prospective trials are needed to elucidate and confirm these findings. In this video, we explain step-by-step the technique of vaginal cuff closure before a radical hysterectomy performance for uterine cervical cancer. First, the nodal status is established by laparoscopic sentinel lymph node dissection and frozen section study. Bilateral pelvic lymphadenectomy is completed according to the size of the tumor. In the case of negative nodal status, the vaginal cuff is closed: Approximately 2 to 3 cm from the tumor (depending on its size), a circumferential incision of the vaginal mucosa is performed, followed by the dissection of the vaginal wall, which should be sufficient to allow a tension-free vaginal closure. The vaginal cuff is then closed with a running suture. A laparoscopic radical hysterectomy is then completed, and the surgical specimen is removed without any manipulation of the tumor. Avoiding manipulation of the tumor during cancer surgery is crucial. A vaginal cuff closure technique appears to be an easy protective maneuver that prevents tumor exposure and manipulation during laparoscopic radical hysterectomy.

Re: Issues around vaginal vault closure

Re: Issues around vaginal vault closure

Comparison between laparoscopic and vaginal suturing in closing the vaginal vault in Total Laparoscopic Hystrectomy

Abstract Background Hysterectomy is defined as surgical removal of the uterus. It is one of the most gynecological operations all over the world. Benign diseases are responsible for more than 70% of the indications for hysterectomy. e.g: fibroids, pelvic pain and menstrual disorders. Aim of the study to compare between laparoscopic route and vaginal route in vaginal vault closure in total laparoscopic hysterectomy. Patients and Methods This comparative study was carried out between March 2018 and October 2018, at Ain Shams maternity hospital and Helwan materinity hospital, a prospective randomized control comparative study of 32 ladies undergoing total laparoscopic hysterectomy after obtaining the approval of the local ethical committee and a fully-informed written consent. Results A total of 32 patients were included in the study and they were divided into 2 groups each group consisted of 16 patients, the first group of patients underwent laparoscopic suturing and the second group underwent vaginal suturing. Each group was further subdivided into vertical (8 patients) and horizontal (8 patients). Both groups were matched for age, parity, BMI, menstrual status, comorbidities, previous cesarean sections and indications for hysterectomy. Conclusion Vaginal vault closure can be performed safely and effectively both vaginally and laparoscopically.Vaginal route for vault closure was shorter and easier than laparoscopic route.Vaginal horizontal suturing was comparable to vaginal vertical. Laparoscopic vertical was easier and faster than laparoscopic horizontal.

Mid-urethral sling revision for mesh exposure-long-term outcomes of two surgical techniques from a comparative clinical retrospective cohort study.

To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid-urethral sling (MUS). Clinical retrospective cohort study. Tertiary urogynaecological centre in Australia. Women with urodynamic stress urinary incontinence (SUI) who had a MUS (n = 2823) during 1999-2017 with a follow-up period up to December 2018. Thirty-three women (1%) had sling exposure and 31 required surgical intervention (1%). Clinical review with analysis of surgical database and patient records. The primary outcome was successful closure and resolution of exposure-related symptoms without the need for re-surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision. Mean follow up was 103months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had 'successful' closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery. Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. TWEETABLE ABSTRACT: #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure.

Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction.

To measure the neuromuscular activation of the pelvic floor and abdominal muscles concurrently with vaginal closure forces induced during a hypopressive exercise (HE) and to identify the contribution of the HEs sequences (posture and maneuver) in the muscle's activation. A cross-sectional study design was employed. Sixty-six women who had participated in a physical therapy program focused on HEs were recruited. Pelvic floor muscle (PFM) activation was measured using surface electromyography (sEMG) in supine and in the orthostatic position, and vaginal closure force was measured through vaginal dynamometry in supine. Activation of the abdominal, gluteal, and hip adductor muscles was measured using sEMG. Maximum effort voluntary contractions (MVCs) of the PFMs and reference contractions of the abdominal and hip muscles were acquired for normalization purposes. A HE was then performed in a supine position with one leg raised, then in an orthostatic position. During the supine HE, the peak PFM sEMG amplitude was 74.4% to 86.5% (49.6%-109.6%) of MVC, the peak vaginal closure force was between 51.2% and 55.7% (95.5%-382.9%) of MVC, and the muscles of the lateral abdominal wall were activated between 25.4% and 35.3% of the reference contraction. During the orthostatic HE, PFM activation was 61.4% (40.1%-105.6%) of MVC, and the lateral abdominal wall muscles contracted at 22.8% of the reference activation level. The PFMs, abdominal, gluteal, and adductor muscles are activated during the performance of a HE. The activation level of the PFMs and abdominal muscles is likely insufficient to result in strength gains; however, they could have an endurance effect.

Laparoendoscopic Single-site Radical Hysterectomy with Vaginal Closure and without Uterine Manipulator for FIGO IB1 Cervical Cancer

Minimally invasive surgery (MIS) for radical hysterectomy (RH) has been reported with inferior oncologic outcomes in the New England Journal of Medicine [1,2]. Some studies have suggested that the no-touch technique may be a useful procedure to prevent tumor spillage and improve survival. Therefore, we performed RH targeting early-stage cervical cancer using the laparoendoscopic single-site (LESS) approach with an enclosed colpotomy and without a uterine manipulator [3]. Video demonstration of the technique. A hospital. A 48-year-old postmenopausal woman received a diagnosis of stage IB1 (International Federation of Gynecology and Obstetrics, 2018) cervical cancer [4]. After being fully informed of the benefits and risks of different surgical approaches (laparotomy and MIS), she consented to the MIS. The type C RH through the LESS approach was performed successfully. The final pathologic findings confirmed stage IB1 cervical carcinoma. The patient recovered quickly, albeit with slight pain, and the incision scar was hidden perfectly for cosmetic purposes. This video demonstrates that LESS-RH with vaginal closure and without a manipulator is feasible and safe. Suspension skills played a significant role in LESS-RH. In addition, this surgical procedure involved 4 specific techniques to prevent tumor spillage: creation of a vaginal cuff, avoidance of a uterine manipulator, standard type C radical hysterectomy, and bagging of the specimen. These adaptations were meant to minimize tumor manipulation and disruption for reducing the increased risk of recurrence. However, further verifications are still required.

Prospective Interventional Study to Quantify Barbed Suture Exposure at Vaginal Vault and Assess Post-Operative Risk

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

Transvaginal Cystocele and Rectocele Repair, Using a New Very Simple Suturing DE-ALWIS TECHNIQUE

The purpose of this exercise is to introduce a very simple new technique of epithelial closure, in this case the vaginal wall. The new technique (the de Alwis method) has been used by us for decades. Proplapse of the uterus or several pelvic organs has been a problem for centuries and a most embarrassing experience for many. Different surgical and nonsurgical measures have been performed over centuries. The de Alwis method of vaginal epithelial wall approximation is shown to be cosmetically most accepted in our unit and has had no adhesions nor granulation tissue formation. Purpose: A different technique of vaginal repair with the de Alwis suturing technique of epithelium approximation, over a twenty-year period. Method: This is a retrospective review of 41 patients who underwent vaginal repairs with the de Alwis method suturing technique, for over a decade. In many, the Baden-Walker halfway classification was used before and during follow-up. Four elderly frail patients, with vaginal vault prolapsed and who were not sexually active, opted for Le Forts’ colpocleisis. Transvaginal vaginal repair followed by vaginal epithelial closure using the de Alwis surgical technique, had no granulation tissue formation, and was cosmetically satisfying.

How we perform a posterior sacrospinous ligament fixation by the vaginal route.

Posterior sacrospinous fixation (SSF) was first described by Amreich in 1950 and then modified by Richter in 1968. The main difficulty of this technique is the pararectal approach with dissection under visual guidance. Our aim was to teach young surgeons to use this alternative technique for apical suspension and to facilitate the pararectal approach. We divide the sacrospinous ligament fixation technique into ten surgical steps: exposure, infiltration, vaginal incision, recto-vaginal dissection, pararectal dissection, SSL suture, vaginal fixation (with vaginal strips), vaginal closure, SSF and final closure. We have performed > 500 SSFs following the sacrospinous ligament fixation technique. Inexperienced surgeons are generally not comfortable with the dissection of the SSL. A video of the procedure with pararectal dissection, SSL identification and suturing clearly shown can help to perform this technique. The use of vaginal strips has been designed to help strengthen the vaginal part of the SSF. It is important to share such a video showing how to approach the pararectal fossa with a dissection under visual guidance. The aim is to help young surgeons better understand the surgical technique and dissection.

Subsequent Use of a Pressure Sensor to Record Intra-Abdominal Pressure After Maximum Vaginal Closure Force in a Clinical Trial.

Pelvic floor disorders are caused by weakening or damage to the tissues lining the bottom of the abdominal cavity. These disorders affect nearly 1 in every 4 women in the United States and symptoms that drastically diminish a patient’s quality of life. Vaginal closure force is a good measure of pelvic health, but current vaginal dynamometers were not designed for the rigors of hospital reprocessing, often failing due to sensor degradation through repeated sterilization processes. In order to obtain measurements of vaginal closure force in a large study, we designed a vaginal dynamometer that utilizes a removable intra-abdominal sensor already in production for the study. The sensor’s existing data acquisition system was modified to transmit to a tablet allowing the user to view data in real-time. The new speculum design allowed a single sensor to measure vaginal closure force before being used to collect intra-abdominal pressure data in the same study visit. The measurements taken with the new speculum were similar to measurements taken with a previously reported vaginal dynamometer.

1959 Laparoscopic Resection of Bladder and Uterine Cervix Endometriotic Nodule

Video Objective Laparoscopic resection of bladder endometriosis is associated to the benefits of a minimally invasive approach. In this video, we aim to describe the surgical strategy applied in the treatment of anterior compartment deep endometriosis with bladder and uterine cervix infiltration. Setting Academic and public hospital. Patients A 37-year-old patient, with dysmenorrhea since the menarche, dysuria and dyspareunia for the last 3 years, without improvement with medical treatment. Complementary exams showed a 2,18cm bladder endometriosis nodule with an extension to cervical and anterior isthmic region of 1,87cm, and a proximity to the ureters bilaterally. The patient desired possible future fertility. Interventions Laparoscopic approach for treatment of bladder and uterine lesion. Measurements and Main Results Laparoscopic surgery identified the limits of the lesion. Nodule affected the round ligament bilaterally, bladder, and uterine serous layer. Both ureters were dissected since iliac bifurcation until uterine vessels. Horizontal incision was performed on the bladder around the lesion until the foley catheter visualization to avoid de ureteral meatus. Vesicouterine space was dissected and an 5cm lesion compromising the uterine serous to the cervix was removed. Yabuki space was recognized during the nodulectomy. Vaginal closure was made primordially followed by the vesical suture using 0 and 2-0 polygactin respectively. Operation was successfully completed. Patient was discharged 5 days later. Foley catheter and prophylactic antibiotic were used for 10 days. Social, urinary and sexual activities with improvement in pain and better quality of life. Conclusion Urinary tract endometriosis is a rare disease, but when it occurs the bladder is the most affected site. Patients often complain of dysuria, hematuria, and chronic pelvic pain. Partial bladder cystectomy offers complete removal of endometriotic nodule promoting improvement of urinary symptoms and quality of life.

Laparoscopic Management of Posthysterectomy Vesicovaginal Fistula

Video Objective To show our standardized method to surgically tackle posthysterectomy vesicovaginal fistulas by laparoscopy. Setting Universitary hospital, and reference center for gynecological diseases. Interventions We present two cases of posthysterectomy vesicovaginal fistulas referred to our hospital. Both had abdominal prior hysterectomies. We maintained Foley´s catheter 3 months prior to definitive surgery to avoid usual acute inflamation surrounding the fistula. We followed a very standardized method which consists of 5 steps: 1.- Anatomical survey / Adhesiolysis, 2.- Identification of vesicovaginal avascular space, 3.- Fistula identification, 4.- Further dissection of the vesico vaginal space, 5.- Individual vesical and vaginal defect closure. Conclusion Both patients were discharged 48 hours after surgery. Foley´s catheter was maintained for 14 days. We had performed such surgery in 6 consecutive cases with no fistula relapse.

<p>Intraperitoneal cytology after laparoscopic radical hysterectomy with vaginal closure without the use of a manipulator for cervical cancer: a retrospective observational study</p>

PurposeAlthough laparoscopic radical hysterectomy (LRH) has been performed for patients with cervical cancer because of its minimal invasiveness, a recent large prospective study showed that LRH was associated with a lower rate of disease-free survival and overall survival. However, the reason for these results is not apparent. The aim of this study was to evaluate the tumor spillage during LRH with vaginal closure without the use of a manipulator.Patients and methodsTwenty-four patients with cervical cancer underwent total LRH with vaginal closure. To evaluate the leakage of cancer cells during surgery, peritoneal cytology was performed before and after hysterectomy.ResultsAmong 24 patients with cervical cancer, 2 had stage IA2 disease, 19 had stage IB1 disease and 3 had stage IIA1 disease. Two patients had lymph node metastasis. The median tumor size on final pathology was 9 mm. No cancer cells were identified before or after hysterectomy in any patients.ConclusionTotal LRH with vaginal closure did not increase the propensity for tumor spillage in the peritoneal cavity.

Issues around vaginal vault closure

Key content Vaginal cuff dehiscence (VCD), vault prolapse, vaginal cuff granulation and infected vault haematoma are adverse events following hysterectomy. There are several approaches to closing the vaginal cuff, each using different techniques and sutures. Dehiscence of the vaginal cuff is more common with laparoscopic hysterectomy. Techniques that minimise excessive use of diathermy may reduce the risk of vault dehiscence. The incidence of post‐hysterectomy vault prolapse is estimated to be between 1.8% and 11.6%. McCall culdoplasty seems to be effective in supporting the vaginal vault. Different techniques are used to minimise the development of vault haematoma and granulation tissue. Learning objectives To understand the different techniques used for vault closure during hysterectomy. To understand the different surgical approaches used to reduce the risk of vault dehiscence, vault prolapse and haematoma after hysterectomy. To understand the post‐operative care procedure that should be followed after hysterectomy to minimise the risk of vaginal vault complications. Ethical issues Patients should be aware of the risk of vaginal vault dehiscence, vault prolapse, haematoma and granulation tissue formation after hysterectomy. Trainees should be well trained using simulators, be supervised when performing laparoscopic vaginal vault closure and be made aware that vaginal closure is another safe treatment option.

Modified colpocleisis for repair of pelvic organ prolapse post-radical cystectomy.

Since the era of neoadjuvant chemotherapy, complications of pelvic organ prolapse (POP) post-radical cystectomy have become more common; however, the exact incidence is not documented in the literature. The objective was to repair post-radical cystectomy POP, despite the lack of endopelvic fascia normally needed for this type of repair. Three patients aged 60 to 80 had symptomatic POP (of all three compartments: apical, anterior, and posterior) following radical cystectomy and ileal conduit urinary diversion, and no interest in maintaining their coital abilities. Two of the three women were status post-hysterectomy. Colpocleisis, which is known to have a success rate of almost 100%, was performed on the first two patients, with a recurrence of the prolapse shortly after this correction (2-4months), probably due to the lack of endopelvic fascia. Following the failure of the procedure, a side-to-side closure of the vagina was performed. The latter was the procedure of choice performed on the third patient. We present a video clip of the vaginal closure to demonstrate the procedure performed. Repair was successful in all three cases, with no relapse to date (4months post-surgery). Closure of the vaginal canal successfully treated POP in our case series. There were no intra- or postoperative complications in any of the cases. Patients were discharged the following day and did not show any signs of recurrence at follow-up (3, 5, and 6months post-surgery).