Vaginal vault suturing

 

I had the rare privilege to train with Dr Tony McCartney, the inventor of the McCartney tube. The tube is a surgical device that is instrumental to performing a Total Laparoscopic Hysterectomy (TLH).

It maintains the pneumoperitoneum during a laparoscopic procedure and allows surgeons to complete the entire operation laparoscopically; it even allows gynaecological surgeons to suture the vagina laparoscopically once the uterus has been removed.

Compared to Total Abdominal Hysterectomy, high-level evidence suggests that laparoscopic hysterectomy is associated with …

  1. A 30% reduction in surgical adverse events
  2. Better quality of life outcomes after surgery and quicker recovery
  3. Cost-effectiveness because the slightly increased surgical equipment costs are dwarfed by the savings in shorter hospital stay.

In my early days when Dr McCartney taught me, it took me an hour to complete the TLH but it would take me then another 2 hours to suture the vagina laparoscopically. How often did I wish I could turn the operation around vaginally and suture from “below”? How often did I break the suture and I had to start all over again? How many times did I tangle the sutures and I had to untangle them in a long and painful way? How often were my shoulders hurting like hell and I wish I could give up?

In these early days the process of suturing was a lot harder and took a lot longer than the TLH procedure itself.

Nowadays I am very grateful that Dr McCartney put up with me for being slow, with me for being grumpy and exhausted and that he dismissed all my desperate suggestions we could suture from “below”. Nowadays, suturing the vagina takes me a mere few minutes and in addition we can see all relevant structures, such as bladder, rectum and ureters very clearly.

I have been involved in teaching TLH since I practice gynaecological surgery independently since 2003 and consistently found that my students also struggle with laparoscopic suturing more than with any other step of a TLH.

This video is an attempt to simplify the teaching of laparoscopic vaginal vault closure; to break the complexity of suturing down into small steps that can be learnt, memorized and made reproducible.

 

Have fun and enjoy!