The patient is a 53 yo F with stage III symptomatic rectocele.
1. Installation/ Positioning
The patient is in gynecological position. We used 4 trocars.
2. Exposure to/of the operative field
Thanks to a pronounced Trendelenburg position the sigmoid loop is retracted appropriately. The uterus is fixed on the anterior abdominal wall.
Findings: Douglas pouch is enlarged. Excces peritoneum is excised allowing for the exposure of the pelvic floor.
3. Dissection of the rectovaginal space
We used an intravaginal buggy. The dissection was performed to the deepest part of the pelvic floor and lateral, to the pararectal fossa
4. Promontorium approach
There are 3 risks:
– median sacral artery;
– intervertebral disk;
– the hypogastric plexus;
In the same time the right ureter must be identified, being localized very close to the area of dissection. Scissor were used to make a 3-4 cm peritoneal incision
The blunt dissection was used to create a bridge/space/oppening between the promontorium and the Douglas pouch.
6. Lower fixation of the prosthesis
The prosthesis is 6/6 cm inferiorly and the superior part is 2,5 /9 cm. The fixation is performed with Protack device and with the help of an intralumenal finger.
7. Fixing the prosthesis to posterior vaginal pouch/fornix is stretching / is putting tension on the posterior vaginal wall. We used an intravaginal finger for contrapressure
7. Suspension to the posterior vaginal pouch(fund de sac post vaginal) allow (punerea in tensiune) a tension of posterior vaginal wall. 2 agrafes are put with the control of an intravaginal finger>>>.aici tre schimbat ca m-a apucat oboseala…sper ca totusi ai inteles
8. Fixation to the promontorium
Is realized by Protrack device avoiding the intervertebral disk.
It’s about a technique without tension of the prosthesis
9 Peritoneal closure
Is performed using Vicryl 2/0 continuous suture both at the level of Douglas pouch and promontorium.
No drainage, no naso gastric tube are needed.
Postoperatively, first bowel movement was on day one which allows for progressive realimentation/ feeding. Hospital stay was 4 days.
Session: Podium Video Presentation
Program Number: V044