ABSTRACT
OBJECTIVES: The pathology of the pelvic floor, including the urinary incontinence, the anal incontinence and the genital prolapse, is very dominant, concerning approximately a third of the adult women. It is fundamental that this musculature supports a good function, because of the weakness of the pelvic floor produces urinary incontinence, cysto and rectocele, genital prolapses and sexual dysfunctions. The above mentioned pathology can be corrected by laparoscopic promontofixation, whatever the previous history of pelvic surgery, including the placing of prosthetic material. In this article we describe the above mentioned intervention. MATERIAL AND METHODS: Preoperative care is standardized and is accompanied by antibiotic prophylaxis, preventive antithrombotic treatment and in the event of a history of pelvic surgery, a digestive preparation. Positioning of the patient must plan a 30° Trendelenbourg position. After the introduction the trocars, initial surgery comprises anterior dissection of promontory after incision of the posterior peritoneum with the patient placed beforehand in a Trendelembourg position. After that, we make interrectovaginal dissection to free the whole posterior surface of the vagina. This is followed by the installation of a posterior mesh pre-cut in an arc. After intervesical vaginal dissection, the anterior prosthesis comprising a precut polyester mesh is fixed avoiding excess traction. The end of the surgery involves careful reperitonization of all the prosthetic parts. Possible specific surgical complications are vascular and visceral wounds. RESULTS Y CONCLUSIONS: The technique allows the correction of the dysfunction of the pelvic floor and incontinence with good anatomical and functional results. Postoperative secondary haemorrhage and gastrointestinal occlusion may occur. Occurrence of an inflammatory syndrome and low back pain suggests spondylodicitis and MRI should be performed. Vaginal erosion on the prosthesis may occur after several months and seems relatively independent of the prosthetic material used.
Subject(s)
Gynecologic Surgical Procedures/methods , Laparoscopy , Pelvic Organ Prolapse/surgery , Urologic Surgical Procedures/methods , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Urologic Surgical Procedures/adverse effectsABSTRACT
Laparoscopy is a major part of urologists' daily practice. It is becoming more and more popular and interest in it is increasing, as is the number of urologists attracted by it. Patients also frequently demand a treatment through a laparoscopic approach. Nevertheless, laparoscopy is a physically and technically demanding surgery. It has been proven that it has a long learning curve with a high complication rate at the beginning. Thus, there is need for a training program that can effectively reduce its time of apprenticeship. The learning path is a multistep process that involves several phases. The pelvic trainer is the first step of this path that is made with increasing difficulty. Gradually and gently the trainee faces up to different levels under the guidance of a mentor. At the end of training, trainees should be able to perform every procedure, both easy and difficult ones, by themselves.
Subject(s)
Laparoscopy , Urologic Surgical Procedures/education , Cadaver , Clinical Competence , Computer Simulation , Humans , Internship and Residency , Mentors , Models, Animal , Models, EducationalABSTRACT
Axial oblique views were performed during cineangiography of congenital heart disease on patients of a paediatric cardiological unit for a period of two years. The resulting angle-patterns are shown in a synoptical review, and indications for angiographic demonstration of morphological conditions in congenital heart disease are discussed. In comparison with the literature to date, this is the first report of experience with a biplane synchronised "C" arm cineangiographic system.
