Laparoscopic Vault (prolapse ) Repair :

Indication:
Performed for pain in lower abdomen or for something com in g out
Per vaginum or passing of urine on s training (coughing, weight lifting etc.)
Objective :
Incidence of vault prolaps e s eems to have been increased following
non-descent vaginal hys terectom y and abdominal hys terectomy in las t few
years becaus e of overall life expectancy of all fem ales has increased and
today wom en desires better quality of life after 60s of her age. More than
50% patients dis closes the fact that she passing urine on coughing or
laughing in patients along with vault prolaps e and she wants relief for this
dis tressing and long s tanding s ymptom since m any years .
Vault prolapse is found to be associated with multiple pelvic floor
defects and this can be better identified laparos copically and addressed
appropriately & anatom ically. Address ing anterior. Mid and pos terior
compartm ents defects repair from below m ay be inadequate and m ay
leads to recurrent vault prolaps e after vaginal repair. Today concept of
identifying defects in pelvic endo-pelvic fas cia and offering mesh support
for adequate repair has become popular for better results . Thes e multiple
pelvic defects are identified and Anterior or mid or Posterior compartm ent
defects repair are done sys temically to prevent reoccurrence. Vaginal
vault can be fixed with m esh and then mes h with s acral promontory with
tacker. This s urgery requires lot of experience & expertis e.
PID, Tuberculos is , Endometriosis & pas t s urgeries are the
commones t caus es of adhes ions found around pelvic genital organs and
anterior abdom inal wall causing pain in lower abdom en along with
prolapse. Post Laparotom y & post vaginal hysterectom y, adhes ions are
found in 20-70% of cas es following various Gynecological surgeries
leading to subs equent adhes ions & pos t operative pain requiring
Laparoscopic Adhesiolys is . Fact may ins pire all patients to as k prim ary
surgeon for not offering initial Gynaec surgery by Laparos copic approach.
Adhes iolys is is the mos t rewarding s urgery in pain relief.
Benefits of Laparoscopy Surgery:

Shorter Hos pital s tay,

Earlier return to your routine work,
Cosm etically vary s mall s car,
Less pain after operation,
Bes t fertility enhancem ent & Fertility res ults following Laparoscopy,
Video-live operative file available in CD/DVD for future reference
(Transparency about s urgical procedure).

The poss ibility of pos t-operative adhes ion formation will be less ,
and the poss ibility of pain becaus e of pos t-operative adhes ions will
als o be less .
Special advantages of laparoscopic Vault repair are:
o Better pain relief after operation,
o Less chances of redo surgery for vault prolapse again,
o Comprehensive and anatomical repair of multiple pelvic
floor defects repair well
o Finally better sexual quality because of good vaginal
depth after laparoscopic repair.

Pre-operative Check Lists:

(1) Lab. Investigation for Surgery (Urine complete & Blood complete,
HbsAg, HIV, R.B .S.) Pelvic Trance vaginal USG report
(2) Specific Inves tigations for ass ociated problems .
(3) Operation planned after good vaginal m ucos a support by estrogen
application for at leas t 7 days & prolaps e reduction protocols before
planning surgery.
(4) Two days of liquid diet before operation and Special Peglac / Colonwash (Powder diss olved in one liter of drinking water and patient is
as ked to drink every 10 m inutes till the s ame colored fluid comes out
ins tead of s tool) s ix hours prior to operation & preparation/s having of
local parts.
No. Of Cuts on Abdomen:
Three cuts : all of 5 mm s ize.
Average Stay in Hospital:
12-24 hours . (DAY CARE SURGERY)
Average Duration of Surgery:
50-70 m inutes
Average Blood loss during Surgery:
30-60 cc
Average time after operation to resume normal activities/work:
Within 24 hours .
Anesthesia:

General Anes thesia (Patient will not feel any pain in Operation Theatre
during surgery)
Operative Procedure:
Jus t below Umbilicus sm all needle is introduced and Co2 gas is
ins ufflated inside abdom en. Rather than creating a large incis ion and
opening up the body, tiny incisions are made and a laparos cope is
ins erted. This s lim scope has a lighted end. It takes pictures actually
fiber optic images - and s ends them to a m onitor s o the surgeon can see
what is going on ins ide.
Performing laparos copy usually only requires three tiny incis ions
less than one half inch, (about 5-10 m illimeters) in length. With previous
midline s car on abdomen, we generally introduce verres needle through
palm ers point and then firs t 5 mm port is introduced through Palmers
point. . This allows the s urgeon a better view and m ore working s pace to
maneuver the laparos cope and surgical tools as needed. Us ing sm all
incis ions rather than opening the abdomen lessens recovery tim e as well
as dis com fort and makes s urgical s cars less noticeable. With help of
palm ers point port, second 5 mm port is kept supra um bilically on vis ion
above the m idline intra abdom inal midline adhesions . Third port is kept on
Rt s ide near anterior superior iliac spine on vision. Adhes iolys is is done
with Bipolar & s cissor and adhes ions are s tretched from one s ide
simultaneously
Vaginal s tent is pushed from below. Peritoneum near the
bladder is identified and Bladder is diss ected down and laterally.
Pos teriorly rectum is diss ected down to expose pos terior vaginal wall till
pelvic floor. Peritoneum is opened on pelvic brim and peritoneum is
diss ected down, medial to Rt. Uterosacral ligament, away to RT Ureter till
Rt vaginal apex below. Lower two ends of the m es h is sutured with
anterior and pos terior wall vaginal walls by No.1 Vicryl s titches and
proxim al m esh end is fixed with s acral promontory with tacker (sm all
screw fixes with sacral prom ontory) Peritoneal clos ure s tarted with Lt.
Angle with No. 1 Vicryl by continuous closure and mes h totally covered
with peritoneum .
Mos t of the tim e many patients undergo laparos copy as Day care
procedure, returning home within 24 hours of s urgery. For normal
laparoscopy procedure takes about 15 to 35 minutes only. For m ore
complicated cas e it may take 1-2 hour. Mos t begin feeling much better
within one day.
Post-operative Course:
Patient rem ains drows y/s edated for 2-3 hours after laparos copy but
cons cious & pain free. Patient can take fluids 6-8 hours after laparos copy
& light food after 8-10 hours. She may feel little abdominal & shoulder pain

after laparos copy for 24 hours but it cam be relived with pain killer tabs .
Mos t of the patients can walk norm ally without s upport and can take
norm al diet 12hours after the laparos copy. Folys catheter is rem oved on
next day. She can be dis charged on the next day of the operation. Few
patients may feel naus ea & vom itin g after laparos copy, which can be very
well controlled with injection in pos t-operative room . Patient can do her
norm al activity within 24 hours after laparos copy. Patient is advised to
take antibiotics & analges ic tabs . for 5 days following la paroscopy. Patient
is advised to report to doctor for s evere pain or bleeding or fever in
pos toperative period (Day-1 to Day-5) imm ediately. Patient is advised to
come for follow up 7 days after the Laparos copy for dress ing.
FAQs :
(1) When I will able to do normal activities after my operation?
(2) No. Of Hospital visits required for Laparoscopic surgery?
(3) Why other doctors have not advised Laparoscopic surgery
during in last 3-4 years?
(4) How to judge the surgical competence/ safety of
Laparoscopic surgery?

my

(5) Chances of redo surgery after my Laparoscopic surgery?

(6) Can I get copy of the video DV D of my proposed Laparoscopic
surgery?
(7) Will you allow my relative to attend my Laparoscopic surgery
in Operation theatre?
(8) Can I know how you are sterilizing all
equipments for my Laparoscopic surgery?
(9) How many hospital visits
Laparoscopic surgery?

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Laparoscopic

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