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Vaginal Paravaginal Sidespecific repair

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this is a medical professional presentation

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  • intereasting ,of greate value,it could be more helpful if accompanied with audio comments on the stepes of surgery
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Vaginal Paravaginal Sidespecific repair

  1. 1. VaginalParaVaginalRepair (VPVR) Anterior vaginal prolapse repair Using a side specific technique and bolstering repair with SurgiSIS Andri Nieuwoudt Terneuzen www.nieuwoudt.nl
  2. 2. Matthew Barber John DeLancey
  3. 3. Ischial spine Paravaginal defect
  4. 5. www.nieuwoudt.nl
  5. 6. www.nieuwoudt.nl Left paravaginal defect
  6. 7. cervix Obturator internus fascia (ATFP) Pubic rami Symphasis pubis Ischial spines
  7. 8. Effect of Plication on paravaginal defect
  8. 11. Pull direction in prolapse
  9. 12. Correcting the mechanical deffect
  10. 13. Ti-Cron Vicryl Placing sutures
  11. 14. Ti-Cron Vicryl Side-specific Repair (using the same sutures)
  12. 15. Ti-Cron Vicryl Sutures anchoring SurgiSIS
  13. 16. Biomesh collagen ingrowth Bolstering with SIS after suturing vesico vaginal septum to sidewall
  14. 17. Biomesh collagen ingrowth Correcting the collagen deffect by bridging with SIS
  15. 19. Uterus <ul><li>Safety zones in Vaginal Surgery </li></ul>Vaginal Surgery Safety rules
  16. 21. bladder Paravaginal disection
  17. 22. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  18. 23. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  19. 24. Cauterization of veins With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  20. 25. 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
  21. 26. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  22. 27. www.nieuwoudt.nl Left paravaginal defect
  23. 28. 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
  24. 29. Ti-Cron Vicryl Placing sutures
  25. 31. Cervix Symphysis Whiteline Sutures baarmoederhals schaambeen With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  26. 32. Placing of sutures on left ATFP Dubble needle holder technique www.nieuwoudt.nl
  27. 33. Deep stich 1 www.nieuwoudt.nl
  28. 34. Deep stich 2 (Ischial spine) www.nieuwoudt.nl
  29. 35. “ superficial “ 1 (bladder neck) www.nieuwoudt.nl
  30. 36. Pubo Urethral Ligament ( cat’s claw) www.nieuwoudt.nl
  31. 37. Placing suture on edge of Vesico vaginal seprum www.nieuwoudt.nl
  32. 38. Incorporating the vesico-vaginal fascia/ septum www.nieuwoudt.nl
  33. 39. Suture running from ATPF through Vesico-vaginal adventitia Deepstich 2 ( ischial spine) Deep stich 1 ( bladder base) www.nieuwoudt.nl
  34. 40. Bladder wall pulled back in position when knots are tied Tying bladder to White line www.nieuwoudt.nl
  35. 41. Inf border of septum High Transverse Defect (HTD) www.nieuwoudt.nl HTD
  36. 42. Closed HTD www.nieuwoudt.nl
  37. 43. www.nieuwoudt.nl before Side specific repair
  38. 44. www.nieuwoudt.nl Site specific repair(HTD)
  39. 45. before after www.nieuwoudt.nl
  40. 46. Bolstering with SurgiSIS www.nieuwoudt.nl
  41. 47. Baie Dankie Thanking you www.nieuwoudt.nl
  42. 48. Anyone interested to learn the Vaginal Side Specific Repair can contact the webmaster

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