PelvicOrganReconstructive Surgery

PelvicOrganReconstructive Surgery With compliments Andri Nieuwoudt Applying the Flagpole Concept in POR surgery

Requirements of the vaginal support system Anterior Wall: Mobility Posterior Wall: mobility Top: Stability

Requirements of the vaginal support system Anterior Wall: Mobility Posterior Wall: mobility Top: Stability = Temporary Scaffold = Semi-permanent Scaffold = Permanent solid support flag pole

Break PelvicOrgan supports up into different “organs” The Flagpole concept The pole The flag

Break PelvicOrgan supports up into different “organs” The Flagpole concept The pole

Requirements of the vaginal support system Anterior Wall: Mobility Posterior Wall: mobility Top: Stability = Temporary Scaffold = Semi-permanent Scaffold = Permanent solid support flag pole biomesh Synthetic mesh

The Damage to the Rectovaginal septum The breaking of the POLE

With compliments dr Andri Nieuwoudt www.pelvicorganreconstruction.com

rugae With compliments dr Andri Nieuwoudt www.pelvicorganreconstruction.com Photo`s and slide by dr Richard Reid Recto-enterocele Linear EPF tear Enterocele defined Enterocele sac

Repairing the Posterior compartment

With compliments dr Andri Nieuwoudt www.pelvicorganreconstruction.com Photo`s and slide by de Richard Reid Recto-enterocele Linear EPF tear Enterocele defined Enterocele sac

Sacro-spinous lig Sacro-spinous lig

Requirements the vaginal support system Anterior Wall: Mobility Posterior Wall: mobility Top: Stability = Temporary Scaffold = Semipermanent Scaffold = Permanent solid support flag pole Biomesh (SIS) Synthetic mesh

With compliments dr Andri Nieuwoudt www.pelvicorganreconstruction.com

Repairing the anterior compartment

1.Enter superficial Anterior Vaginal wall cleavage plain 1.Insnijding in de natuurlijke spatie in de vaginale voorwand With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

Blaaskatheter Catheter Vaginal wall Bladderwall With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

2. Penetrate attenuated lateral septum 2. Doodringen van zijwand scheiding tussen voorwand en zijde van bekken. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

bladder vagina Paravaginal disection

With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

Cauterization of veins With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

3. Sweep Bladder (& Ureter) medially 3. Stroop blaas en urineleider na binnen ( weg van de bekkenzijwand) With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

4. Place 4 pairs of stay sutures in Whiteline or Obturator membrane 4. 4 hechtingen paren worden door whiteline of binnen membraan van bekkenwand geplaatst With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

Cervix Symphysis Whiteline Sutures baarmoederhals schaambeen With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

5. Reconstruct “ trampoline” with SIS from whiteline to whiteline from Symphysis to cervix 5. Reconstructie van kapotte ondersteuning van de blaas met SIS van whiteline tot whiteline (zijwanden) van schaambeen tot baarmoederhals. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

bladder vagina

Symphysis pubis Cervix schaambeen baarmoederhals With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

Break PelvicOrgan supports up into different “organs” The Flagpole concept Baie dankie vir u aandag With compliments dr Andri Nieuwoudt www.pelvicorganreconstruction.com

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PelvicOrganReconstructive Surgery

by nieuwoudt on Nov 24, 2006

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PelvicOrganReconstructive Surgery — Presentation Transcript