Following is a brief summary of the surgical procedure.
Caution: This information is for educational purposes only. Refer to operating room manuals and procedure videos for more detailed instructions on this surgical procedure.
View the PerigeeTM System Instructions for Use document.
Step 1
Make preferred incision for anterior repair.
Step 2
Infiltrate to facilitate hemostasis and dissection.
Step 3
Dissect the bladder laterally towards the ischiopubic ramus to facilitate the needle passage.
Step 4
Reduce the cystocele with interrupted sutures if required, starting at the inferior end of the cystocele.
Step 5
Mark needle entry points on the vulvar skin. Superior mark is roughly at the level of the clitoris, at the lateral edge of the ischiopubic ramus. Inferior marks 3 cm below and 2 cm lateral to the superior point. Confirm that the entry point markings are anatomically appropriate by vagino-vulvar palpation using thumb and index finger.
Step 6
Insert superior needle first. The angel of the needle is roughly 45 degrees from the patient's midline. Repeat on the contralateral side.
Step 7
At each pass pull the length of the arms until the armpit of the graft is at the lateral edge of the cystocele.
Step 8
Insert inferior needle with the handle roughly parallel to the patient's midline. The tip of the needle should be pointed directly at the ischial spine. The desired exit point is along the white line within 2 cm of the ischial spine. Once passed, you may have to rotate the handle to facilitate the connector fixation. Repeat on the contralateral side.
Step 9
Pull each arm through until the armpit of the graft is at the lateral edge of the cystocele.
Step 10
The mesh should now sit underneath the cystocele in a tension-free manner. The tail of the mesh should be drawn down to the lower most portion of the cystocele. Attach the tail at this point or leave it free, depending on preference. The redundant tail should be trimmed off.
Step 11
The vaginal incision should be trimmed if required and closed with interrupted sutures.
Step 12
Remove plastic sheaths, cut mesh arms and skin incisions, and close skin incisions.
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