The author, Dr. C.Y. Liu, is a noted authority on the laparoscopic approach to pelvic floor reconstruction. In Part 1 of this article (OB.GYN. NEWS, October 1, 2004, p. 58). Dr. Liu discussed the anatomy of the pelvis, pelvic support problems that occur over time, and the preoperative evaluation and treatment of pelvic support defects.
In this second installment, Dr. Liu takes the reader step-by-step through the laparoscopic reconstruction of genital prolapse. In particular, he focuses on the repair and support of defects within the posterior compartment as well as vaginal vault suspension. Part 2 also discusses the use of graft material, which is becoming more popular in pelvic floor reconstruction.
C.Y. Liu, M.D., who is in private practice in Chattanooga. Tenn., has regularly chaired the postgraduate course on the laparoscopic treatment of pelvic floor disorders at the annual meeting of the American Association of Gynecologic Laparoscopists. In addition, he has spoken throughout the United States as well as internationally on this subject.
In the coming months, other Master Class columns will discuss vaginal vault prolapse and will address laparoscopic and vaginal mesh suspension.
RELATED ARTICLE: Dr. Miller Says To Remember These Key Points
* Identify and dissect out ureters.
* Use rectal and vaginal probes to delineate the enterocele.
* For vaginal vault suspension, use the proximal uterosacral ligaments in the repair.
* Consider graft material for a large prolapse or previous failed repair.
BY CHARLES E. MILLER, M.D.
DR. CHARLES E. MILLER, a reproductive endocrinologist in private practice in Arlington Heights, Ill., and Naperville, Ill., is the medical editor of this column.