Redo promontofixation procedure

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.

Da Vinci surgical system Laparoscopic approach in the treatment of recurrent genital prolapse. Redo promontofixation procedure.
Professor Puchkov K.V. is performing an operation (2019).

The film shows the technique of redo promontofixation procedure for genital prolapse III stage. In 2017, the patient underwent a robotic (da Vinci) hysterectomy without appendages and promontofixation with a mesh implant fixation to the anterior wall of the vagina. After 5 months, relapse developed. At the first stage, the pararectal space on the right was dissected with a 5 mm monopolar electrode and the dissection of the right lower hypogastric nerve. An excess mesh length was detected (stretching or inadequate selection of its length during the first operation). The fixation of the proximal edge to the promontory is reliable. In this regard, it was decided not to cut off its proximal part, but to cross the implant in the middle part. Next, lightweight promontofixation with a soft mesh implant MEDTRONIC COVIDIEN was performed according to the author's methodology (patent from 2015). The new implant was fixed to the distal part of the mesh in the area of the dome of the vagina and its proximal part, with adequate tension. The suture material was non-absorbable V-lock (MEDTRONIC COVIDIEN) and Prolen thread. Peritoneum was closed with Monocryl thread. The anterior and posterior colporrhaphy with levatoroplasty was also performed. The duration of the laparoscopic phase of the operation was 40 minutes. The patient was examined after 3 months, no complaints.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.