Perigee >>
Perigee System for Transobturator Cystocele Repair
Perigee Figure: 1 |
Perigee System for Transobturator Cystocele Repair: The picture depicts the graft used for anterior wall repair. The graft is 5cm wide by 10cm long. The apical portion of the graft has a tail on it that can be cut to fit the length of the patients vagina. It has 4 arms coming off laterally that are attached to the pelvic sidewall with needles passed through the transobturator space. The pink needles are the superior needles and are used to attach the bladder neck arms (same needles and pass of the Monarc TOT sling). The gray needles are the inferior needles that are used to attach the apical arms of the graft to the white line up near the ischial spines on each side. A macroporous polypropylene graft may be used as shown in the picture, or a biologic porcine graft is also available.
Needle Pass and Graft Attachment Points
Perigee Figure: 2 |
Needle Paths and Attachment Points for Graft: The above diagram depicts the areas that the needles come through the sidewall of the pelvis and ultimately where the arms of the Perigee graft will be attached. The arms are brought back out the sidewall and provide a robust attachment through the fascia and the arcus (whiteline) itself. Anatomic dissections have shown these areas to be very safe distance away from any nerve or vascular structures.
 Perigee Figure: 3 |
 Perigee Figure: 4 |
Superior needle pass |
Inferior/Apical needle pass |
The above pictures depict the needle passes through the groin to enable connection of the anterior wall graft to the pelvic sidewalls. Very small incisions are made in the groins on each side. The superior incision is in the genitofemoral crease beneath the adductor longus tendon (same spot as Monarc TOT sling) and the inferior incision is 3cm inferior and 2cm lateral to this. Once the needles are passed, the arms of the graft are attached to the needles and pulled out through the groin incisions. The arms are then adjusted and tightened which adjusts the graft to support the bladder back up in its normal anatomic position. The tail of the graft is cut to fit the length of the patient's vagina and is attached up to the vaginal cuff (or pericervical ring if uterus is in place) prior to arm adjustment. The mesh graft forms a new floor under the bladder and supports it from the opening of the pubic bone up to the top of the vagina and from pelvic sidewall.
Perigee Figure: 5 |
Perigee Figure: 6 |
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