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Conization of the Cervix

The term cone biopsy has come to refer to not only biopsy of the geometric cone but also cylinder and disc biopsies (loop excision of the T-zone). Over the past three decades, a great deal of research and discussion has focused on the specifications for conization of the cervix. Principally, the goal of the gynecologic surgeon is to obtain a clear (i.e., non-neoplastic) cell margin at…

Abdominal Sacral Colpopexy and Colpohysteropexy

Suspension of the vagina or vagina and uterus to the sacral promontory by means of an abdominal, laparoscopic, or robotic approach has been shown to be an effective treatment for uterovaginal prolapse and vaginal vault prolapse. Although the exact indications for abdominal sacral colpopexy are controversial, I prefer this procedure to a vaginal repair when there is obvious failure of the compensatory support mechanisms of the…

Native Tissue Suture Repair of Vaginal Vault Prolapse: Laparoscopic, Robotic, and Open Abdominal Approaches

More than 400,000 hysterectomies are performed annually in the United States (a decline of more than 200,000 in annual procedure numbers from the peak in 2002). In 2018 the most common route of hysterectomy was laparoscopic (to include both traditional and robotic), followed by the abdominal and vaginal approaches. Although most hysterectomies are done for reasons other than lost vaginal support, some data demonstrate that failure…

Retropubic Urethropexy for Stress Incontinence and Retropubic Paravaginal Repair

Modified Burch Colposuspension After the retropubic space is entered, the urethra and anterior vaginal wall are depressed. Dissection at the midline is avoided, thus protecting the delicate musculature of the urethra and urethrovesical junction from surgical trauma. Attention is directed to the tissue on either side of the urethra. The surgeon’s nondominant hand is placed in the vagina with the index and middle fingers on one…

Tubal Sterilization

Tubal interruption, or bilateral partial salpingectomy, is a relatively easy and direct method of accomplishing surgical sterilization. Typically, this operation is performed at the time of cesarean section, or immediately postpartum in the case of vaginal delivery. Two operations are especially well suited for these particular circumstances. Modified Irving and Pomeroy techniques are enhanced because further tubal separation may be anticipated as the result of rapid…