2013 Annual Meeting-Methylene Blue As A Visual Aid For Robotic Sacrocolpopexy

Video Transcription

At the time of the exam on anesthesia, the surgeon evaluates the vagina and the defect they are preparing to repair.  It is at this point where methylene blue is injected to be used as a visual aid  for the surgeon to recognize the extent of their dissection plane laparoscopically for robotic sacrocopalpexy.  Alice clamps her place anteriorly where the vaginal fascial break is noted and there is lack of vaginal rugae.  At this location, methylene blue is injected underneath the vaginal mucosa so that we can see this laparoscopically.  In a similar fashion, methylene blue is also injected posteriorly where the vaginal fascial break is noted as well.  Attention is then turned to the laparoscopic portion of the procedure. At this point, the dissection was started posteriorly.  The rectovaginal space was developed. As one can see, it was spread laterally to ensure adequate space for the mesh.  The rectovaginal space was developed with blunt dissection and monopolar scissors to where the methylene blue dye could be visualized.  Visualization of the methylene blue gave the surgeon the visual cue he needed to locate the apex of his posterior dissection.  The rectovaginal space was developed with blunt dissection and monopolar scissors to where the methylene blue dye could be visualized.  The rectovaginal space was developed with blunt dissection and monopolar scissors to where the methylene blue dye could be visualized.  Attention was then turned to the anterior dissection between the vagina and the bladder.  The vesicovaginal space was developed again with both blunt dissection and monopolar scissors.  This was taken down to where methylene blue dye could be seen where the fascial break was noted.  Further dissection of this was needed to ensure adequate space for mesh placement was obtained.  The anterior and posterior dissection compartments were then measured and the Y-measure was used.  The anterior and posterior dissection compartments were then measured and the Y-measure was used.  The anterior and posterior dissection compartments were then measured and the Y-measure was cut to approximate specifications.  The mesh was sutured in anteriorly and posteriorly with quill suture.  Care was taken to make sure the mesh was secured and placed at the apex of the dissection both anteriorly and posteriorly.  Following placement of the mesh with good distal and apical support, attention was turned to the sacral promontory.  The tail of the mesh was brought through the tunnel and attached to the sacral promontory.  The peritoneum was closed over the remainder of the vagina ensuring no mesh exposure.

Video Summary

In this video, the surgeon is preparing for a robotic sacrocopalpexy procedure to repair a vaginal defect. Methylene blue dye is injected into the vaginal mucosa to aid in visualizing the extent of dissection during laparoscopy. The rectovaginal space is developed using blunt dissection and monopolar scissors, ensuring enough space for the mesh. The surgeon locates the apex of the posterior dissection using the visual cue provided by the methylene blue dye. The vesicovaginal space is also developed with dissection and scissors, and further dissection is done to accommodate the mesh placement. The Y-measure is used to measure and cut the anterior and posterior dissection compartments to the required size. The mesh is sutured in place with quill sutures, securing it at the apex. The tail of the mesh is attached to the sacral promontory and the peritoneum is closed over the vagina to prevent mesh exposure. No credits were granted in the transcript.

Meta Tag

Category surgical video

Category prolapse-robotic

Category robotic

Category surgery

Category Minimally Invasive Procedures

Category imaging

Category PFD Week 2013

Session 182188

Keywords

surgeon

robotic sacrocopalpexy procedure

vaginal defect repair

laparoscopy

methylene blue dye