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| Name | An Approach to Apical Support: Laparoscopic McCall’s Culdoplasty |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 13-11-2024 23:12:18 |
| Video Discription | Laparoscopic McCall’s culdoplasty provides apical support during hysterectomy to prevent post-operative pelvic organ prolapse by securing the vaginal vault to the uterosacral ligaments. This five-step technique includes precise suturing and cystoscopy to ensure ureteral safety. See full transcript here: www.cansagevideos.com/apical-support-laparoscopic-mccalls-culdoplasty Presented By Dr. Anna Shishkina Dr. Azra Shivji Dr. Elizabeth Miazga Dr. Andrea Simpson Dr. Elaine Shore Affiliations St. Michael’s Unity Health Toronto University of Toronto Timestamps (00:08) Objectives (01:00) Pelvic Organ Prolapse (POP) (01:16) POP Risk Factors (01:23) POP Post-Hysterectomy (01:55) Hysterectomy and Indications for Vault Suspension (02:28) Comparison of Approaches to Apical Suspension (03:03) Laparoscopic vs Vaginal McCall's (03:27) Step 1: Marking Uterosacral (03:48) Step 2: Vault Closure (04:22) Step 3: Hemostasis (04:38) Step 4: McCall's Placement (06:40) Step 5: Cystoscopy (06:51) Possible Complications (07:06) Summary Laparoscopic McCall’s culdoplasty is a prophylactic technique performed during hysterectomy to prevent post-hysterectomy pelvic organ prolapse, a condition impacting up to 50% of women and often associated with significant quality-of-life concerns. Pelvic support involves multiple levels, with Level One support, provided by the uterosacral and cardinal ligaments, being critical for preventing vault prolapse. McCall’s culdoplasty reinforces this support by attaching the vaginal apex to the uterosacral ligaments, minimizing prolapse recurrence. The procedure includes five key steps: marking the uterosacral ligaments for precise suturing, closing the vaginal vault with secure sutures, achieving hemostasis, placing McCall’s sutures to obliterate the posterior cul-de-sac, and performing cystoscopy to verify ureteral integrity. These steps provide apical support and ensure that potential issues, such as ureteric injury, are avoided. Research supports the effectiveness of McCall’s culdoplasty in preventing vault prolapse, with comparable success between vaginal and laparoscopic approaches. This technique offers a reliable preventive option for patients, with benefits discussed in shared decision-making to determine if prophylactic suspension is appropriate. |
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