Surgical Systems And Methods For Transvaginal Apical Suspension

Abstract

Systems and surgical methods and procedures for performing transvaginal apical suspension are provided.

1 . A method for transvaginal apical suspension comprising:
 passing a first end of a suture through a pubococcygeus muscle, an iliococcygeus muscle, a coccygeus muscle, and tendinous structure near a sacrum of the patient;   securing a first end of a mesh to an apex of the vagina of the patient and a second end of the mesh to the first end of the suture;   suspending the apex of the vagina of the patient by pulling a second end of the suture; and   passing the second end of the mesh through the tendinous structure near a sacrum of the patient by said pulling.   
     
     
         2 . The method of  claim 1  further comprising the step of creating an insertion tunnel along a posterior vaginal wall for an entire length of a vagina of a patient. 
     
     
         3 . The method of  claim 2  wherein the step of creating an insertion tunnel along a posterior vaginal wall for an entire length of a vagina of a patient comprises making an incision starting from outside the vagina at a perineal body of the patient. 
     
     
         4 . The method of  claim 1  wherein the step of creating an insertion tunnel along a posterior vaginal wall for an entire length of a vagina of a patient comprises dissecting skin off the patient's perineal body and exposing a rectal-vaginal space of the patient. 
     
     
         5 . The method of  claim 1  wherein the step of passing a first end of a suture through a pubococcygeus muscle, an iliococcygeus muscle, a coccygeus muscle, and tendinous structure near a sacrum of the patient and into the insertion tunnel comprises passing the suture through a levator plate of the patient. 
     
     
         6 . The method of  claim 1  wherein the step of passing a first end of a suture through a pubococcygeus muscle, an iliococcygeus muscle, a coccygeus muscle, and tendinous structure near a sacrum of the patient and into the insertion tunnel comprises passing the suture through a muscle above the surface of the sacrum of the patient. 
     
     
         7 . The method of  claim 1  wherein the step of suspending the apex of the vagina of the patient by pulling a second end of the suture comprises cutting the second end of the mesh where the mesh traverses the pubococcygeus muscle of the patient. 
     
     
         8 . The method of  claim 1  further comprising the step of making an incision in an anterior vaginal wall of the patient and repairing a cystocele. 
     
     
         9 . The method of  claim 1  further comprising the step of passing the second end of the mesh through the tendinous structure near a sacrum and the coccygeus muscle of the patient by said pulling. 
     
     
         10 . The method of  claim 1  further comprising the step of passing the second end of the mesh through the tendinous structure near a sacrum and the coccygeus muscle of the patient and through at least one of the iliococcygeus muscle and pubococcygeus muscle of the patient by said pulling. 
     
     
         11 . A method for transvaginal apical suspension comprising:
 creating an insertion tunnel from a perineal body of a patient towards an apex of a vagina of the patient;   attaching a first end of a mesh to the apex of the vagina of the patient;   suspending the apex of the vagina of the patient by pulling a second end of the mesh through a ligamentous or a muscular anatomical structure of the patient near a sacrum of the patient and through at least one of an iliococcygeus muscle, a coccygeus muscle, and a pubococcygeus muscle of the patient;   anchoring the mesh; and   closing the insertion tunnel.   
     
     
         12 . The method of  claim 11  wherein the step of creating an insertion tunnel from a perineal body of a patient towards an apex of a vagina of the patient comprises making an incision starting from outside the vagina at a perineal body of the patient. 
     
     
         13 . The method of  claim 11  wherein the step of creating an insertion tunnel from a perineal body of a patient towards an apex of a vagina of the patient comprises dissecting skin off the patient's perineal body and exposing a rectal-vaginal space of the patient. 
     
     
         14 . The method of  claim 11  wherein the step of suspending the apex of the vagina of the patient by pulling a second end of the mesh through a ligamentous or a muscular anatomical structure of the patient near a sacrum of the patient and through at least one of an iliococcygeus muscle, a coccygeus muscle, and a pubococcygeus muscle of the patient comprises pulling the second end of the mesh through a portion of each of the iliococcygeus muscle, the coccygeus muscle, and the pubococcygeus muscle of the patient. 
     
     
         15 . The method of  claim 11  wherein the step of suspending the apex of the vagina of the patient by pulling a second end of the mesh through a ligamentous or a muscular anatomical structure of the patient near a sacrum of the patient and through at least one of an iliococcygeus muscle, a coccygeus muscle, and a pubococcygeus muscle of the patient further comprises pulling the mesh through a levator plate of the patient. 
     
     
         16 . The method of  claim 11  wherein the step of suspending the apex of the vagina of the patient by pulling a second end of the mesh through a ligamentous or a muscular anatomical structure of the patient near a sacrum of the patient and through at least one of an iliococcygeus muscle, a coccygeus muscle, and a pubococcygeus muscle of the patient comprises pulling the mesh through a tendonous anatomical structure near the surface of the sacrum of the patient. 
     
     
         17 . The method of  claim 11  wherein the step of suspending the apex of the vagina of the patient by pulling a second end of the mesh through a ligamentous or a muscular anatomical structure of the patient near a sacrum of the patient and through at least one of an iliococcygeus muscle, a coccygeus muscle, and a pubococcygeus muscle of the patient comprises passing a first end of a mesh through a muscle near the surface of the sacrum of the patient. 
     
     
         18 . The method of  claim 11  wherein the step of anchoring the mesh comprises cutting the second end of the mesh where the mesh traverses the pubococcygeus muscle of the patient. 
     
     
         19 . The method of  claim 11  further comprising the step of making an incision in an anterior vaginal wall of the patient and repairing a cystocele.