ENDO STITCH

Laparoscopic pelvic floor repair using the Endo-Stitch:a series of 108 cases over 6

years

Roger A. McMaster-FayDepartment of Obstetrics and Gynaecology,

University of Sydney, Westmead & Penrith.

LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

1. Ureteric Dissection

LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

2. Suture Placement

LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

3. Tying the Knot

LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

4. Suturing the Layers:

Uterosacral ligaments &

Paracolic tissues

LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

5. Case Presentation

With the advent of the Endo-Stitch™ (United States Surgical Corporation, a division of the Tyco Healthcare Group LP) in the

late 1990’s, endoscopic surgeons have been able to perform suturing and intra-corporeal knot tying with this ingenious device.

Endoscopic upper-abdominal surgeons have been using this device with SurgiDac (Dacron) sutures to perform Nissen

Fundoplications for hiatus hernia and reflux.

In 1999 I performed my first laparoscopic pelvic floor repair using this device. I perform a McCall type culdoplasty similar to the

technique described by CY Liu (2005)1, dissecting and mobilizing the ureters from below. Liu uses Gore-Tex sutures as opposed to

a suturing device. I have now performed 108 procedures with none requiring conversion to either abdominal or vaginal procedure. Two thirds were performed with laparoscopic

hysterectomy. There were no direct ureteric or large bowel injuries or obstructions and one inadvertent cystotomy.

Originally I did not obliterate the enterocele sac as was the recommendation of Harry Reich (1999)2. Subsequently a patient

required a laparotomy and bowel resection for obstruction secondary to incarceration in the enterocele sac a few months

after the original surgery. Now I include large ‘bites’ of the para-rectal tissues below the uterosacral ligaments and incorporate

them into the repair. I believe these add important support to the repair.

One patient early in the series required a vaginal repair of rectocele three months after the original procedure. One patient developed a port site herniation of small bowel requiring an open

reduction three days after original surgery (no bowel resection required). Two patients have required a repeat procedure that I

will describe in detail.

Thank you

Pelvic floor repairs for vaginal vault prolapse can be adequately performed laparoscopically using the

Endo-Stitch device.