Sohail A. Siddique

Colpocleisis: a review

Objective: To summarize published data about colpocleisis and to highlight areas about which data are lacking. Data sources: We conducted a literature search on Medline using Ovid and PubMed, from 1966 to January 2004, using search terms “colpocleisis”, “colpectomy”, “vaginectomy”, “pelvic organ prolapse (POP) and surgery”, and “vaginal vault prolapse and surgery” and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search. Methods of study selection: We examined all studies identified in our search that provided any outcome data on colpocleisis. Because of the heterogeneity of outcome measures and follow-up intervals in case series, we did not apply meta-analytic techniques to the data. Results: Colpocleisis for POP is apparently successful in nearly 100% of patients in recent series. The rate of reoperation for stress incontinence or POP after colpocleisis is unknown. Concomitant elective hysterectomy is associated with increased blood loss and length of hospital stay, without known improvement in outcomes. Few studies systematically assess pelvic symptoms. The role of preoperative urodynamic testing to direct optimal management of urinary incontinence and retention remains to be established in this setting. Conclusions: Colpocleisis is an effective procedure for treatment of advanced POP in patients who no longer desire preservation of coital function. Complications are relatively common in this group of elderly patients. Prospective trials are needed to understand the impact of colpocleisis on functional outcomes and patient satisfaction.

Anatomic comparison of two transobturator tape procedures.

OBJECTIVE: Both outside-in and inside-out methods are available for transobturator tape placement. Our objective was to compare these methods regarding proximity of the tape to the obturator canal and ischiopubic ramus. METHODS: Using seven fresh frozen cadavers, transobturator tapes were placed using the inside-out (TVT-Obturator System, Gynecare, Ethicon Inc, Somerville, NJ) and outside-in (Monarc, American Medical Systems, Minnetonka, MN) methods bilaterally in each cadaver. We dissected to the level of the obturator membrane and measured the distance from the closest aspect of the obturator canal and ischiopubic ramus to each tape. RESULTS: Transobturator tapes placed by using the inside-out technique were significantly closer to the obturator canal than with the outside-in method (mean distances: 1.3±0.44 cm compared with 2.3±0.41 cm, respectively, P<.001); the greater proximity of the inside-out method was noted in all dissections. Tapes placed with the inside-out method were also farther from the ischiopubic ramus than those placed with the outside-in approach (mean distances: 0.39±0.44 cm compared with 0.04±0.13 cm, respectively, P=.008). When distances between the tapes relative to the obturator canal were further analyzed according to left or right side, the difference between methods was maintained. Additionally, the distances were consistently farther from the obturator canal on the left side than on the right side regardless of transobturator tape approach. CONCLUSION: The outside-in technique results in the mesh being placed farther from the obturator canal and closer to the ischiopubic ramus, theoretically reducing the risk of neurovascular injury. LEVEL OF EVIDENCE: II

Deep Epigastric Vessel Location in the Gravid Abdomen.

LESS-CLSH (n=20) LAVH (n=36) p value Surgery time (mins) 155.8 40.7 120.3 35.5 0.003 Blood loss 405.6 315.7 316.0 186.0 0.446 Two Phase Laparoendoscopic Single-Site Cervical Ligament-Sparing Hysterectomy: An Initial Experience in a Single Center Complication 0 (0%) 7 (1.9%) 0.361 VAS pain score at 0-4 hrs 6.5 2.1 8.2 1.1 \0.001 VAS pain score at 24 hrs 3.3 1.5 5.1 1.4 \0.001 VAS pain score at 48 hrs 1.2 0.4 2.6 1.3 0.0018 Hospitalisation 4.0 1.1 5.3 0.8 \0.001