Development of generic models for ambulatory vaginal surgery — a preliminary report

Abstract

Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from width to length or into a partial double-layered repair; the creation of artificial neoligaments; the prevention of urinary retention by avoiding tightness in the bladder neck area; local anesthetic infiltration; and buttressing vaginal tissue during wound healing. A total of 108 patients underwent vaginal surgery on an ambulatory or overnight stay basis, 72 under local anesthesia/midazolam. Minimal postoperative pain and the absence of catheterization reduced hospital stay from a statewide mean of 8 days to 1 day, and return to normal activities from 6 weeks to 7-10 days. Cure rates (18 months) were: uterovaginal prolapse 22/22, infracoccygeal sacropexy 21/23, rectocele 36/38, cystocele/anterior vaginal wall prolapse 21/25. Applied as prototypes to reconstructive vaginal surgery, the operations appear to be as effective as traditional techniques but far less invasive. They have the potential to assist working mothers, the old and infirm, and save the community up to $5,500 per patient. It is hoped that the generic models presented may act as a basis for the future development of ambulatory vaginal surgical techniques.

Vault Prolapse II: Restoration of Dynamic Vaginal Supports by Infracoccygeal Sacropexy, an Axial Day-Case Vaginal Procedure

“…Metronidazole 500 mg, gentamicin 80 mg and flucloxacillin 1 g were administered on induction of anesthesia. Three basic rules were followed to achieve a genuine minimally invasive status [4] Perineal Part. This aimed to insert a tape as an inverted 'U' around the rectum and attach it behind the posterior vaginal wall via the ischiorectal fossa (Fig.…”

“…It was reasoned that the main reason for the recurrence of vault prolapse after surgery was not only weakness of the tissues, but also disruption of the wound before it had cross-bonded sufficiently [4]. The healing wound, like Araldite glue, has very little strength until the wound collagen cross-bonds adequately [5].…”

“…Excessive suture tightness (compression) around ligaments may cause pain because the vagina, like bowel, has a visceral nerve supply. A 'tension-free' approach to tissue restitution helps avoid problems associated with excess tightness, and is a principal factor in permitting discharge within 24 hours of surgery [4]. Partial herniation of the posterior repair may have been caused by cutting an excessively wide bridge.…”

Anatomical and Functional Outcomes of Posterior Intravaginal Slingplasty for the Treatment of Vaginal Vault or Uterine Prolapse: A Prospective, Multicenter Study

“…The anatomical cure rate was 65.6% and the improvement rate was 34.4% at 12 months after surgery with a success rate of 100%. In the initial preliminary results on P-IVS, success rates of over 90% were reported by Papa Petros [7] and Farnsworth [8]. In recent studies, success rates ranged from 95% to 98% with short-term and medium-term follow-up [9,10].…”

“…The procedure followed the methods introduced by Papa Petros [7] with a tunnelling device (Tyco Healthcare, Norwalk, USA) and polypropylene tape (Tyco Healthcare, Norwalk, USA). For patients who had concomitant surgeries, additional procedures were performed after closure of the P-IVS wound.…”