Bilateral iliococcygeal fixation for vaginal vault prolapse and enterocele repair using a new suturing device--the digital needle driver.
The objective of our study was to evaluate the surgical feasibility, efficacy and safety of the digital needle driver (DND 202), a modified, flexible surgical device, during iliococcygeal fixation (ICF) for vaginal vault prolapse and enterocele repair. A prospective longitudinal study was carried out among 21 consecutive patients who underwent bilateral iliococcygeal fixation at St George's Hospital, London. All patients filled a comprehensive questionnaire for pre- and post-operative prolapse, urinary, bowel and sexual symptoms and underwent pre- and post-operative site-specific vaginal examination, following the standardized International Continence Society scoring for prolapse, pre-operative urodynamic studies and analysis of the surgical results. The outcome measures were the feasibility of the procedure, the time needed, intra- and post-operative complications, short-term post-operative prolapse-associated symptoms and pelvic organ prolapse quantification. The mean age of the patients was 65 [5] years and the mean body mass index (kg/m(2)) was 23 [2.7]. In addition to ICF, 8 patients underwent vaginal hysterectomy, 18 had posterior repairs, 7 had anterior repairs and 6 had TVT. The mean time for ICF was 20 [11] minutes, the mean blood loss per surgical procedure was 264 [225] mL and the mean hospitalization time was 4.6 [1.2] days. Postoperatively, one patient had mesh erosion. At short-term post-operative evaluation none of the patient had prolapse symptoms. There was a statistically significant improvement in all stages of the apical and posterior walls prolapse (p < 0.001). The mean total vaginal length was significantly shorter postoperatively (7.8 [1.0] cm vs 6.6 [1.4] cm, p < 0.001). Thus, we can conclude that the use of DND device may facilitate the vaginal approach for vaginal vault prolapse and enterocele repair.
Krissi
Haim
H
Department of Obstetrics and Gynecology, Beilinson Hospital, Petah-Tiqva, and Sackler Faculty Of Medicine, Tel-Aviv University, Israel.
Stanton
Stuart L
SL
D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D008137:Longitudinal Studies; D009339:Needles; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D014596:Uterine Prolapse / Q000601:surgery*; D014623:Vaginal Diseases / Q000601:surgery*