Summary of sacrospinous colpopexy, a technique used to treat vaginal vault prolapse. Also is called Americh-Richter technique, in honor to the surgeon that popularizes it in Europe.
2. Vaginal vault prolapse
Concept: After hysterectomy when the
apex of the vagina descends below the
introitus so that the vagina turns inside out.
Symptoms: vaginal bulge, pressure,
discomfort, difficulty voiding or defecating,
and sexual dysfunction.
Diagnosis: history and psysical examination.
3. Vaginal vault prolapse
Treatment:
o Non-surgical management: pessaries and
Kegel exercise
o Surgical management: sacrospinous
colpopexy, sacrocolpopexy, uterosacral
colpopexy, colpocleisis…
4. Sacrospinous colpopexy: technique
1. Anterior and posterior median colpotomy.
2. Reconstruction of anterior compartment.
3. Disecction of pararrectal space to ishial spines and reflect
rectum medially with Breisky-Navratil retractor.
4. Visualization of right sacospinous ligament.
5. Insertion of No.0 deleayed absorbable polydioxanone suture
into the right sacospinous ligament 2 cm medial to ischial spine,
using a Deschamps/Miya Hook device or with direct suture.
5. Sacrospinous colpopexy: technique
6. Retrieved sutures with a nerve hook.
7. Bring the stitches out to the apex of the vagina and
fixed there to make a pulley suture.
8. Plicated rectovaginal fascia with the perineum and
close vaginal incision.
9. Tied the sutures and it will pull the vault to
sacrospinous ligament.