How the Z suture is applied in vault closure
|Discussion in 'All Categories' started by Dr. Remigius Izunwa - May 23rd, 2016 1:09 am.|
Dr. Remigius Izunwa
|I want to know How the Z suture can be applied in laparoscopic surgery for the vault closure in hysterectomy and second question is how NPP (Neopectopeg) can be done laparoscopically.|
re: How the Z suture is applied in vault closure by Dr. R. K Mishra - May 23rd, 2016 2:10 am
Dr. R. K Mishra
| Z-suture is a very simple and safe technique of knotless suturing that facilitates suture fixation of vault during hysterectomy. As this is knotless approach it can reliably avoids suture erosion. The needle is simply passed through the layers of vaginal fascia and the emerging polypropylene or dacron suture is secured in a zigzag-shaped suture so it is called (Z-suture). Each pass starts directly adjacent to the exiting site. Five passes are sufficient to reliably fix the suture so that it resists even maximum traction forces. Once this procedure is done, the suture can be cut without any knot. By avoiding suture knots,
As we know vaginal vault even if it is not completely water tight it is OK because it will facilitate the drain of collected blood. Nowadays if you want further easy closure of vault you can use Barbed suture. The V-Loc barbed suture is a good suturing technique that eliminates the need to tie knots, so you can close incisions up to 50% faster without compromising strength and security.
In recent years there has been an increasing uptake in the use of barbed sutures or Z suturing technique, particularly in minimally invasive and laparoscopic procedures where they may reduce operating time and improve surgical efficiency. However, we should keep little is known about the adverse events associated with these new techniques and concerns have arisen regarding their safety in certain procedures.
So in my opinion you should use the laparoscopic extracorporeal knot taking the angle of the vault by doing past pointing so that you are completely sure about the approximation of uterosacral ligament so that there will not be chance of future vault prolapse.
Your another question is regarding NPP laparoscopic pectopexy
The NPP technique was developed in 2007, particularly for those cases in which it is difficult to reach the sacral promontory. In this iliopectineal ligament has long been used as an anchoring structure in incontinence surgery, as described in Burch suspension. Ileopectineal ligament which is also called cooper ligament is also used by surgeons for hernia surgery. Same can be used to pull the vault in case of uterine prolapse by Laparoscopic pectopexy.
Although the role of this surgery is good only in patient where location of Sacral promantory is difficult. This surgery is easier as even in distended bowel seeing the cooper ligament is easy and dissection is mainly to the anterior aspect of pelvis. Pulling effect of vault is pectopexy takes time to appear once the fibrosis of the mesh develop.