Vaginal vault suspension and enterocele repair by Richardson-Saye laparoscopic technique: description of training technique and results.

Objectives: To describe the Richardson-Saye technique for laparoscopic vaginal vault suspension and enterocele repair (vaginal apex reconstruction) and the appropriate training needed for performance of this technique.

Methods: Before using this technique, Drs Carter, Winter, and Mendelsohn first received training by observation of skilled surgeons performing the procedure, attending courses, and finally being tutored and proctored by Dr Saye on the appropriate performance of the technique. They then used this technique to surgically treat eight patients, 42 to 85 years of age, mean age 62 years, between March and September of 1999.

Site-specific fascial defects in the diagnosis and surgical management of enterocele.

Objective: The aim of this study was to assess the surgical feasibility and clinical outcomes of a vaginal enterocele repair that was based on the theory of site-specific defects in the vaginal fascia.

Study Design: Seventeen patients during a 2-year period with a diagnosis of enterocele and vaginal vault descensus with or without coexisting rectocele underwent surgical correction with a site-specific fascial defect repair. An enterocele was defined as vaginal wall prolapse seen during the operation in which the peritoneum was found to be in direct contact with the vaginal epithelium, with no intervening fascia.

Sciatic hernia as a cause of chronic pelvic pain in women.

Objective: To review experience with 20 women treated for sciatic hernia between 1993 and 1997.

Methods: Patients with chronic pelvic pain and sciatic hernias, identified retrospectively from chart review, were seen during a 46-month period that covered the surgical experience at our institution and included approximately 1100 cases. The median length of follow-up was 13 months (range 3-36).

Percutaneous suprapubic teloscopy: a minimally invasive cystoscopic technique.

We describe a percutaneous approach to suprapubic teloscopy that may be used to assess bladder-ureteral integrity during laparoscopic surgery. After access is gained to the hollow of the bladder using a percutaneous suprapubic catheter introducer, a telescope is inserted via the access sheath, and bladder integrity and ureteral patency are confirmed. We describe this technique as a viable alternative to traditional cystoscopy at laparoscopic surgery.