Anterior and Posterior Colporrhaphy

Simulation

Materials and Preparation

Lab Sequence

1. With patient in dorsal lithotomy, place transurethral Foley catheter for recognition of bladder neck and urethrovesical junction
2. Use two Allis clamps to grasp the vaginal epithelium at the urethrovesical junction and at the vaginal apex
3. Inject hydrodissection solution subepithelially (usually a mixture of local anesthetic, saline and vasoconstrictor)
4. With a scalpel, incise the vaginal epithelium between the two Allis clamps, from the urethrovesical junction to the apex
5. Dissect the underlying vaginal fibromuscular tissue from the epithelium to the margins of the dissection bilaterally
   1. Technique: Place an Allis clamp on the epithelial edge. Using your forefinger as traction, use Metzenbaum scissors to carefully dissect the fibromuscular layer away
   2. An assistant can maintain traction medially on the underlying muscularis tissue layer with atraumatic forceps (Providing traction and counter-traction is very important for a clean dissection)
6. With absorbable suture, plicate the prolapsed fibromuscular layer in one or two mattress layers
   1. Wide, shallow bites should be taken bilaterally, starting at the pubic rami so that the prolapsed tissue can be reduced without injury to the underlying bladder
   2. If the prolapse is particularly large, consider imbricating in two layers or place a purse string suture first to reduce some of the prolapse
7. Trim excess vaginal epithelium and reapproximate the vaginal epithelium with delayed absorbable suture
8. Perform cystoscopy for evaluation of bladder integrity and ureteral patency

Contributing Authors

• Chi Chiung Grace Chen, MD
• Michael Fialkow, MD
• Christine Vaccaro, DO