The Vault or the apex is the top of the vagina. It can either descend with the uterus or it can descend after a Hysterectomy. When this happens it is know as a Vault or Apical prolapsed. This next to the cystocele is a challenge that every Pelvic Surgeon faces.
Vault Apex – Vaginal Approach
Laser Sacro Spinous Fixation
The sacrospinous ligament is a strong ligament in the pelvis which serves as an anchoring point for the vault. When the supports of the vagina are weak the ligament is the key anchoring point for vault fixation. The para rectal space on either side of the rectum needs to be dissected and the ligament idebtified. Usually this dissection is bloody due to the presence of the para rectal venous complexes. This can be done bloodlessly using the laser.
Laser McCall Culdoplasty
A procedure originally designed to prevent the formation of an enterocele, the Mc Call Culdoplasty also serves to anchor the vault. There are two types, internal and external. The culdoplasty with vault anchoring requires suture placement with great caution to avoid getting the ureter . The Ho Yag laser is a great tool in facilitating the dissection involved in performing this procedure.
Laser High Uterosacral Fixation
The uterosacral ligament is one of the supports of the uterus. When this weakens or when there is a break in the ligamentous support there is vault prolapse. High uterosacral fixation aims to fix the vault above the break. The Holmium Yag laser helps the process by speeding up the dissection establishing a bloodless field.
Colpocleisis basically means to close off the vagina leaving the passage for the urinary opening intact. The technique followed at the Laser Pelvic Surgery Institute is one of Le Fort partial Colpocleisis with emphasis on preserving the lateral channels . This helps drain the cervix of any secretions that might accumulate later. Laser helps in peeling off the vagina bloodlessly.
Vault Apex – Laser Laparoscopic Approach
Laparoscopic Laser Sacrocolpopexy
This is an abdominal technique for fixing the vault or the apex to a fixed point called the sacral promontory on the sacrum. This can be done Laparoscopically. At the institute the laser is employed to dissect the sacral planes which is a very dicey area to work in due to the adjoining blood vessels and nerve plexus. However, the laser simplifies this and adds a new dimension to the laparoscopic technique. A polypropylene Gynemesh is used to anchor the vault to the sacrum.
Laparoscopic Laser Hysteropexy
In some patients the prolapsed part at the apex may not be the vault but rather the cervix which is the mouth of the uterus would have come down. In these patients instead of doing a Hysterectomy, a Hysteropexy can be achieved with the laser. The laser institute specializes in Hysteropexy using the Hoyag Laser.