The pubic abdominal procedures previously studied. Data on open Burch bilaterally along the pelvic sidewall Fig. Speights et If paravaginal wall defects are injury rate with no ureteral injury when performing a present, then the lateral margins of the pubocervical laparoscopic paravaginal repair with or without a Burch fascia will be detached from the pelvic sidewall at the using four to five sutures bilaterally total eight to ten arcus tendinous fascia pelvis.
To facilitate identification, sutures. The authors attribute the lower complication it is often necessary to elevate the vagina with a finger in rate to the experience of the surgeons and the the vagina while gently dissecting the bladder and the visualization afforded by laparoscopy. Often, the broken edge of the pubocervical fascia has fallen inferior Level 2 and 3 support: laparoscopic approach to the bladder and its elevation is the optimal method to to rectocele repair discern the discrete fascial break.
Once appropriately Laparoscopic repair of a rectocele is infrequently dissected, the lateral margins of the detached pubocer- performed as most gynecologic surgeons find the vaginal vical fascia and the broken edge of the white line can approach to be preferred.
The first suture is placed near the apex of the vagina The technique employees open laparoscopy and place- though the paravesical portion of the pubocervical fascia. The rectovaginal The needle is then passed through the ipsilateral septum is opened using electrocautery, harmonic scalpel, obturator internus muscle and fascia around the arcus or laser. Blunt dissection with dissectors, hydrodissection tendineus fascia at its origin cm distal to the ischial or sharp dissection may be used to open the rectovaginal spine.
The sutUre is secured using an extracorporeal space distally to the perineal body. This dissection knot-tying technique. Good tissue approximation is should follow surgical planes and is often bloodless.
The accomplished without a sutUre bridge. SutUres are placed perineal body is sutured to the rectovaginal septum sequentially along the margins of the paravaginal defects using delayed absorbable suture. The rectovaginal fascial from the ischial spine toward the urethrovesical junction.
If the patient does not demonstrate stress urinary If the rectovaginal fascia is detached from the iliococcy- incontinence or urethral hypermobility, a series of four geus fascia, it is reattached with number 0 nonabsorbable to five sutUres are placed ipsilaterally between the ischial suture.
The medial aspect of the levator ani muscles may spine and the mid urethra. If the patient has bilateral also be plicated, but care should be taken to avoid a paravaginal defects, the same technique is employed on posterior vaginal ridge [19].
In our experience, unilateral paravaginal defects are rare. No long-term complications were noted [20]. The rectovaginal septum revisited: its relationship to the traditional vaginal approachto rectocele adopted by rectocele and its importance in rectocele repair.
Clin Obstet Gynecol 1 ; The anatomic defects in rectocele and enterocele. J Pelvic Surg ; Operative technique for the repair of Laparoscopy should only be considered a mode of posthysterectomy vaginal prolapse.
Ann Chir Gynaecol ; Post-hysterectomy enterocele and vaginal vault prolapse. Am J Obstet Gynecol ; technique of operative reconstructive surgery. Laparo- Anterior vaginal wall culdoplasty at vaginal decreasing blood loss and magnifying the pelvic floor hysterectomy to prevent posthysterectomy anterior vaginal wall prolapse.
Am J Obstet Gyencol; Other advantages, 7 Ross JW. Apical vault repair, the cornerstone of pelvic floor reconstruction. Techniques of laparoscopic repair of total vault eversion after quality of life, have also been described in the literature. J Am Assoc Gynecol Laparosc ; Site specific fascial defects in the increasedoperative time and associatedincreasedcosts. Am J Obstet Gynecol ; Vaginal vault suspension and is similar and in many times reduced especially for 00 enterocele repair by Richardson-Saye laparoscopic technique: description of patients with a high body mass index.
However, training technique and results. J Soc Laproend Surg ; Though this case series is limited by few patients and short term follow-up, a complex operative laparoscopyis associatedwith a steep paucity in the literature addressing laparoscopic enterocele repair along with a well and lengthy learning curve after which operative time written description of the surgical techniques makes this paper a valuable resource for laparoscopic surgeons.
Minimally invasive treatment of urinary stress incontinence and experience and laparoscopyskills as well as the quality laparoscopoicalily direct repair of pelvic floor defects. Clin Obstet Gynecol of the operative team. Carbon dioxide laser for laparoscopic A thorough knowledge of pelvic floor anatomy is enterocele repair.
J Am Assoc Gyencol Laparoscop ; Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gyneco; Vaginal vault suspension. Endosc Surg ; surgeryand suturing are essentialto perform the surgical Promontofixation for the treatment of of literature, laparoscopicpelvic reconstructive surgery 00 prolapse. UrolClin NorthAm ; This presents an excellent discussion of surgical technique by surgeons who have will continue to be driven by patient demandsas well as probably performed more laparoscopic prolapse surgery than almost any others in surgeonpreference.
With increasing experience, greater the world. Laparoscopic paravaginal repair plus Burch colposus- pension: review and descriptive technique. Urology ; 56 SuppI6A Frequency of lower urinary tract injury at Papers of particular interest, published within the annual period of review, have laparoscopic burch and paravaginal repair.
J Am Assoc Gynecol Laparosc been highlighted as: ; Laparoscopic surgery for genuine stress urinary incontinence and pelvic organ prolapse. Clinical urogynecology. St Louis: CV Mosby; Delancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Laparoscopic rectocele repair using polyglactin mesh. Obstet Gyencol; JAm Assoc Gynecol Laparosc. Related Papers Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse By Cindy Amundsen.
Surgical repair of vaginal prolapse: A gynaecological hernia By Charlotte Chaliha. Abdominal sacrocolpopexy: a comprehensive review By Halina Zyczynski. Download PDF. All surgeries were performed by the two senior reproductive laparoscopists JG and XMY and every surgical procedure was video recorded.
After clinical examination diagnostic laparoscopy was performed to identify any possible pelvic pathology. Diluted methylene blue was injected transcervically which enabled distention of the tube and assessment of tubal patency. Particular attention was given to the tubal status: tubal blockage, the quality of the mucosa, and the tubal wall aspect during laparoscopy. Laparoscopic surgeries consisted of thorough ablation or excision of all peritoneal and non-peritoneal endometriotic lesions, lysis of adhesions, and appropriate management of tubal disease.
Adhesions present were similarly lysed to restore pelvic anatomy. Surgical treatment of tubal pathologies included laparoscopic neosalpingostomy, fimbrioplasty and salpingectomy. The decision to repair or remove fallopian tubes is usually made intraoperatively based on status of the tube and tubal mucosa since operative success is dependent on the location, type and extend of tubal injury as we previously described.
Minor or moderate lesions were treated with laparoscopic neosalpingostomy. The primary outcome was live birth rate defined as the proportion of women with delivery of living fetuses and ongoing pregnancy rate defined as the proportion of women with pregnancy beyond 24 or more weeks of gestation.
Secondary outcomes were rates of clinical pregnancy proportion of women with the observation of fetal heartbeat on ultrasound scan , and miscarriage defined as the proportion of women with pregnancy loss before 24 weeks of gestation. Abnormal laparoscopy findings and surgery-related complications were also analyzed. Statistical analyses were performed using a windows-based SPSS version Data were statistically described in terms of mean standard deviation SD , or frequencies number of cases and percentage when appropriate.
For continuous variables, a parametric t test was used to compare treatment groups. When comparing categorical data, Chi-Square test or Fisher exact test was performed. No one was lost to follow-up, however, 2 couples in the control group devoiced during follow-up. Therefore, a total of 88 infertile patients satisfied the eligibility criteria and were analyzed.
No significant differences were shown between the 2 groups in terms of age, infertility duration, number of failed cycles and causes of infertility. No laparoscopy-related complications were reported. Pelvic abnormalities were detected in Mild or minimal endometriosis was present in 15 women, moderate in 9, and severe in 2. Tubal lesions were diagnosed with mild in 4 women, moderate in 4, and severe in 6. Pelvic adhesions were found in 15 patients; in 4 cases no other pathology was observed but 11 of them had coexisting tubal lesions or endometriosis.
In the study group, 19 patients desired spontaneous pregnancy and among them 16 conceived postoperatively. The median interval between surgery and pregnancy was 5 months ranged from 1—26 months. In the control group, 12 were conceived from repeat IVF cycles. Significant difference was found in the per cycle ongoing pregnancy rates between patients in study group and control group A trend toward higher live birth rates that did not reach statistical significance was experienced among patients treated with laparoscopy There were no significant differences observed in terms of miscarriage rates in 2 groups.
In this current study, we encompassed a unique subset of infertile women with multiple failures of IVF cycle. In the study group, laparoscopy revealed pelvic abnormalities in 44 women However, its sensitivity and specificity have been questioned in recent decades. The high incidence of positive pelvic pathology indicated that there are correctable abnormalities that are unfortunately missed by routine pelvic examination and usual imaging procedure.
Laparoscopy seems to be essential in determining potential causes of repeated IVF failures for couples without recognized abnormalities by routine screening. Another endpoint was to assess the reproductive outcomes after surgery. Based on our study, the laparoscopic treatment of all pelvic pathologies in women with otherwise unexplained infertility is likely to be beneficial since it might increase the chance of ongoing pregnancy or live birth.
In the study group, we found that of 30 patients achieved pregnancy, including 16 patients conceived spontaneously and 14 with additional IVF cycle. Patients in our study group experienced repeated IVF cycles before surgery; however, they got pregnant successfully after the mini-invasive surgical approach.
Compared to the study group, only 12 patients conceived from repeat IVF cycles in the control group. Significant difference was found in the per cycle ongoing pregnancy rates between the 2 groups The findings demonstrate a favorable effect of laparoscopic surgery in IVF failure patients, showing that most were able to conceive once potential pelvic pathologies were identified and treated.
Although the surgical role in the management of infertility has been largely supplanted by IVF, the positive significance of laparoscopy cannot be ignored. Sixteen cases of natural pregnancies post-surgery should be regarded as the effectiveness of the surgical procedure. In addition, compared to IVF, reproductive surgery has the potential to restore reproductive function resulting in multiple conceptions after one-time procedure. An early study reported that infertile women have 6 to 8 times the rate of endometriosis compared with fertile women.
Subjects included in our study were all patients with repeated IVF failures and this may account for some of the higher prevalence. In addition, the incidence of endometriosis could be underestimated since the diagnosis is often delayed several years from the onset of symptoms. Several studies have suggested that even in IVF cycles, implantation rates in women with endometriosis tend to be lower than normal.
In this sense, conditions that may impair implantation and successful conception should be corrected before administering IVF. It is our belief that the patients with failed multiple cycles of IVF may harbor a certain type of endometriosis that allows them to benefit from thorough surgical therapy.
But it should be noted that most of the participants in their study were with mild endometriosis. We are not surprised that patients with stage III—IV endometriosis had poor clinical outcomes as compared with patients with milder endometriosis. The association of fallopian hydrosalpinges with decreased pregnancy and implantation rates in IVF cycles has been confirmed by overwhelming scientific evidence, and surgical correction of such lesions before IVF is normally advised.
In our previous study, we have shown that neosalpingostomy prior to IVF in women with mild-to moderate hydrosalpinges improve the outcome of subsequent IVF, while offering the potential for spontaneous conception. Peritubal tubal adhesions adversely affect fertility has been clearly demonstrated. In their study, 69 women were treated by adhesiolysis and 78 were not treated. Admittedly, our study has some limitations as the result of its retrospective nature with the inherent biases that are associated with such design, which may limit its generalizability.
And the number of the study was limited and the issue should be investigated in larger studies. In addition, the cost effectiveness of surgery versus IVF was not covered in our study. Meticulous laparoscopic surgery remains an effective tool in comprehensive evaluation of infertility, particularly for detecting peritoneal endometriosis, adhesions and tubal pathologies. Lewis, M. Kilgore, D. Goldman et al. Serejo, F. Bastos, G. Mota, and P. Thus, our tory Medicine, vol.
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