Mishra Vaginal Vault Retractor
Mishra Vaginal Vault Retractor is a state-of-the-art retractor very useful for laparoscopic sacrocolpopexy, Pectopexy, Cystocele repair, or sling surgery for the patient who has the previous hysterectomy done. It will retract anterior and posterior layers of the vaginal and push it adequately inside the abdomen to separate the bladder and rectum. At the time of performing dual prosthesis sacrocolpopexy, it will help the vaginal fascia to sandwich in between two layers of mesh.
This instrument has a blunt tip and is made up of pure stainless steel so you can autoclave it easily. It has one handle and one fulcrum to give appropriate lever action. Assistant can easily do anteversion or retroversion of vault at the time of separation of urinary bladder or rectum from the vaginal fascia.
Mishra's Vaginal Vault Retractor Vaginal Wall Retractor is used on the posterior vaginal wall to isolate the visualization of the anterior vaginal wall. At the time of fixing the mesh, it gives a rigid platform to use a curve needle without fear of damaging another layer of the vagina.
In patients with Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, it is when the bladder drops from its normal position in the pelvis and pushes on the wall of the vagina. In this situation, it can separate the posterior wall of the urinary bladder from the vagina when you will rub it with a laparoscopic pledget. If the prolapse is left untreated, over time it may stay the same or slowly get worse. In rare cases, severe prolapse can cause obstruction of the kidneys or urinary retention. Vault prolapse is a very common condition after hysterectomy surgery.
Vaginal prolapse is a dropping of your vagina from its normal location in the body. The vagina, also called the birth canal, is the tunnel that connects the uterus to the outside of a woman’s body. Your vagina is one of several organs that rests in the pelvic area of your body. These organs are held in place by muscles and other tissue. These muscles come together to create a support structure. Throughout your life, this support structure can start to weaken. This can happen for a variety of reasons, but the result is the sagging of your organs. When your organs sag or droop out of their normal position, this is called a prolapse.
Prolapses can be small with just a little movement or large. A small prolapse is called incomplete prolapse. A bigger prolapse (called a complete prolapse) is one where the organ has shifted significantly out of its normal place. A complete prolapse can result in part of the organ sticking out of the body. This is a very severe prolapse.
There are several different types of prolapse. Several of the organs in your pelvic area can shift out of place, developing into a prolapse. The different types of pelvic organ prolapse can include:
Vaginal vault prolapse: The top of the vagina (known as the “vaginal vault”) droops down into the vaginal canal. This usually occurs in women who have had a hysterectomy (removal of the uterus).
Uterine prolapse: The uterus bulges or slips into the vagina, sometimes so far that it comes out of the vaginal opening.
Cystocele: The bladder drops into the vagina.
Urethrocele: The urethra (the tube that carries urine away from the bladder) bulges into the vagina. A cystocele and urethrocele are often found together.
Rectocele: The rectum bulges into or out of the vagina.
Enterocele: The small intestine bulges against the back wall of the vagina. An enterocele and vaginal vault prolapse often occur together.
This Mishra's vault retractor is only used if vault the prolapse after hysterectomy. If the uterus is present it will not help.
Vaginal vault prolapse commonly occurs following a hysterectomy (removal of the uterus (womb)). Because the uterus provides support for the top of the vagina, this condition occurs in up to 40% of women after a hysterectomy.
In a vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, effectively turning the vagina inside out. A vaginal vault prolapse is often accompanied by the weakness and prolapse of the walls of the vagina.
Diagnosis of a vault prolapse
Diagnosis is made on the basis of the symptoms and vaginal examination in the clinic. Other tests may be needed to find or rule out problems with your bladder.
Treatment of a vault prolapse
A vaginal vault prolapse is a defect that occurs highs in the vagina, entailing a surgical approach through either the vagina or the abdomen. Generally, laparoscopic surgery is the entry of choice for the surgical treatment for a severe vaginal vault prolapse.
This procedure can be performed either as a keyhole operation (laparoscopic sacrocolpopexy) or as an open procedure. The laparoscopic surgical procedure for correction of vault prolapse is a sacrocolpopexy, in which the surgeon attaches the vagina to a strong ligament over the backbone using a special mesh.
World Laparoscopy Hospital is one of few centres in India that can offer the laparoscopic technique, as it requires a high level of laparoscopic skills and special equipment. We perform many laparoscopic sacrocolpopexy operations and have published our results in peer-reviewed journals.
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