Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding in colpocleisis

Abstract

Introduction and hypothesis Although colpocleisis is a low-invasive surgical option to treat pelvic organ prolapse, it sometimes involves a long operative time with substantial bleeding. To streamline the vaginal dissection process in colpoclesis, we introduced the usage of dermatomes. Methods All patients were sexually inactive women with post-hysterectomy prolapse. Data of the dermatome group were retrospectively compared with those of the historical control group based on operative features, perioperative complications and pathology of dissected tissue. In the dermatome group, 34 women underwent total colpocleisis with vaginal dissection using dermatomes; 4 were done mainly with electric dermatomes, and 30 were done with razor-type dermatomes. In the control group, 20 women underwent total colpocleisis with vaginal dissection using Metzenbaum scissors. Results Using dermatomes in vaginal dissection was helpful to shorten total operative time (including perineoplasty) by one third from 76 to 51 min, to shorten the time of colpocleisis by half, from 62 to 32 min, and to reduce intraoperative bleeding by 76%, from 62 to 15 ml. In addition, none in the dermatome group and 2/20 patients in the control group had unintended peritoneal opening. Dissection with scissors removed not only the epithelium and submucosal layer but also the muscle layer. This was minimized with razor-type dermatomes and never occurred with electric dermatomes. Whereas electric dermatomes are difficult to get accustomed to and are expensive, razor-type dermatomes enable thinner dissection compared with scissors, are easy to handle and are inexpensive. Conclusions Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding. Therefore, they can be recommended as a practical tool for colpocleisis, a prolapse operation mainly for frail elderly patients.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

“…Anatomical success defined as POP-Q stage ≤1 ranged from 62.5% to 100% [ 7 , 12 , 15 , 24 , 26 , 29 , 43 ]. Eisenberg et al reported an anatomical success rate of 62.5% (POP-Q ≤1), but the success rate increased to 100% when they extended the definition to POP-Q ≤2 [ 24 ].…”

“…Only a few authors have addressed regret over the loss of sexual function. No regret regarding coital ability was reported by many studies [ 1 , 7 , 11 , 18 , 22 , 25 , 35 , 43 ], but coital regret was reported too: from 1.15% to 12.9% [ 17 , 23 , 32 , 37 ]. In a study by Fitzgerald et al, 3% (2 out of 79), 87% (69 out of 79), and 10% of the women (8 out of 79) reported “worse,” “the same,” or “better” sexual function respectively, after 1 year of follow-up [ 29 ].…”

“…Therefore, many researchers assess the results of the anti-incontinence procedure performed concomitantly with colpocleisis [ 6 ]. One study demonstrated that the denudation of the vagina with razor-type dermatomes allowed the preservation of a thicker fibromuscular layer of the pubocervical and rectovaginal fascia and reduction of operative time [ 7 ]. Despite having a considerable history, the search for improvements to the procedure of colpocleisis continues, aiming to ensure high efficacy and low risk of complications and side effects.…”

Surgical Assessment of Tissue Quality during Pelvic Organ Prolapse Repair in Postmenopausal Women Pre-Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial

“…On the other hand, difficulties in dissection or tissue handling increase the incidence of intraoperative complications such as bladder/visceral injury, bleeding and so on [ 10 , 11 ]. In particular, in cases with post-hysterectomy prolapse, the vaginal wall tends to be thin; thus, vaginal dissection becomes difficult, and unintended opening of the peritoneum may occur [ 12 ].…”

Comparison of blood loss between saline infiltration and no infiltration dissection during vaginal prolapse surgery -randomized controlled trial

“…There are very few published studies on interventions to reduce blood loss during vaginal prolapse surgery. In a study on colpoclesis razor dermatome dissection was found to be faster and associated with lesser bleeding among women undergoing colpoclesis for prolapse [16].…”