ENDO%20STITCH

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ENDO STITCH
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Laparoscopic pelvic floor repair using the
Endo-Stitcha series of 108 cases over 6
yearsRoger A. McMaster-FayDepartment of
Obstetrics and Gynaecology, University of Sydney,
Westmead Penrith.
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LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

• 1. Ureteric Dissection

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LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

• 2. Suture Placement

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LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

• 3. Tying the Knot

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LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

• 4. Suturing the Layers
• Uterosacral ligaments
• Paracolic tissues

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LAPAROSCOPIC UTEROSACRAL VAGINAL VAULT SUSPENSION

• 5. Case Presentation

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With the advent of the Endo-Stitch (United
States Surgical Corporation, a division of the
Tyco Healthcare Group LP) in the late 1990s,
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.
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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.
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Thank you

• Pelvic floor repairs for vaginal vault prolapse
  can be adequately performed laparoscopically
  using the Endo-Stitch device.