To highlight several advanced surgical techniques for all types of colpocleisis. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population.<sup>1Nygaard I, Barber MD, Burgio KL, e al. Prevalence of symptomatic pelvic floor disorders in US women JAMA 2008 ;  300 : 1311-1316 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti,2Wu JM, Vaughan CP, Goode PS, e al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women Obstet Gynecol 2014 ;  123 : 141-148 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Particularly for women with advanced pelvic organ prolapse who no longer desire penetrative vaginal intercourse and with multiple medical comorbidities, the obliterative approach is preferred due to decreased anesthetic needs, operative time, and perioperative morbidity.<sup>3Fitzgerald MP, Richter HE, Bradley CS, e al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis Int Urogynecol J Pelvic Floor Dysfunct 2008 ;  19 : 1603-160910.1007/s00192-008-0696-6 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Additionally, colpocleisis is associated with a greater than 95% long-term efficacy with low patient regret, high satisfaction, and improved body image.<sup>4Crisp CC, Book NM, Smith AL, e al. Body image, regret, and satisfaction following colpocleisis Am J Obstet Gynecol 2013 ;  209 : 473.e1-473.e710.1016/j.ajog.2013.05.019

Cliccare qui per andare alla sezione Riferimenti,5Wang X, Chen Y, Hua K. Pelvic symptoms, body image, and regret after LeFort colpocleisis: a long-term follow-up J Minim Invasive Gynecol 2017 ;  24 : 415-41910.1016/j.jmig.2016.12.015 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>

The umbrella term of “colpocleisis” encompasses a uterine-sparing procedure, the LeFort colpocleisis, colpocleisis with hysterectomy, and posthysterectomy vaginal vault colpocleisis. We demonstrate the surgical steps of performing each type of colpocleisis as well as levator myorrhaphy and perineorrhaphy, which are typically included to reinforce the repair.

To streamline the LeFort colpocleisis procedure, we demonstrate use of electrosurgery to mark out the epithelium and methods to create the lateral tunnels with LeFort colpocleisis with and without the use of a urinary catheter. We also present techniques that can be utilized across all types of colpocleisis including the push-spread technique for dissection, tissue retraction with Allis clamps and rubber bands on hemostat clamps to improve visualization, and approximation of the anterior and posterior vaginal muscularis to close existing space. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. We use an anatomic model to demonstrate appropriate suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles in order to adequately narrow the vaginal opening. Ultimately the goal of the colpocleisis procedure is a well-approximated, obliterated vagina, approximately 3 cm in depth and 1 cm in width.

The skills demonstrated enable the surgeon to maximize efficiency and surgical outcomes for an effective obliterative procedure for advanced stage pelvic organ prolapse.