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Minimally invasive approach.

With the first baby boomers entering their 7th decade, a large female population is now faced with concerns about vaginal vault prolapse. Because many of these patients are older and in compromised health, the need for a minimally invasive approach is not only desired, but of paramount importance.

Dr. C.Y. Liu, who is in private practice in New York, is one of a handful of world authorities of the laparoscopic approach to pelvic floor reconstruction. A past member of the board of trustees of the American Association of Gynecologic Laparoscopists, Dr. Liu first presented on laparoscopic retropubic colposuspension (Laparoscopic Burch) in 1991.

In 1994, he began lecturing on pelvic reconstructive surgery. Over the past 10 years, Dr. Liu 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.

Dr. Liu is also widely published. His first article on laparoscopic retropubic colposuspension was published in 1993.

By 1996, he was writing articles on laparoscopic treatment of vaginal prolapse and enterocele repair.

Because of the complexity of the topic, this Master Class will be presented in two parts. This month, Dr. Liu offers an overview of the functional dynamics of the pelvic floor, the surgical anatomy, the clinical assessment of prolapse, and patient preparation. Next month, he will take readers step-by-step through his laparoscopic surgical approach.

In the coming months, expect a series of Master Class columns addressing vaginal vault prolapse. Experts will present overviews on a number of state-of-the-art procedures, including laparoscopic and vaginal mesh suspension.

RELATED ARTICLE: Key Points to Remember, Selected By Dr. Miller

* Perform the exam with the patient in an upright position and ask her to strain forcefully.

* Inspect the anterior and posterior vaginal walls separately and thoroughly using the posterior half of a vaginal speculum.

* In postmenopausal women, unless contraindicated, use estrogen for 6-8 weeks before surgery.


DR. CHARLES E. MILLER, a reproductive endocrinologist in private practice in Arlington Heights, Ill., and Naperville, Ill., is the medical editor of this column.
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Title Annotation:The Master Class
Author:Miller, Charles E.
Publication:OB GYN News
Date:Oct 1, 2004
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