TEACHING SACROSPINOUS COLPOPEXY

OBJECTIVE: A method is described by which residents can perform transv aginal sacrospinous colpopexy simply, quickly, safely, and effectively . STUDY DESIGN: Over 11 years, 134 sacrospinous suspension procedures have been performed, all or in pari by residents, under the direct int raoperative supervision of the author. Minimum follow-up is 1 year. An operative technique has been developed with use of standard instrumen ts and lights. The sitting resident, the attending physician, and the medical student are able to see the ligament penetrated by the suture. If necessary, the attending physician is able to perform the difficul t steps of the operation without changing places with the resident. RE SULTS: Results are known for 112 of the patients. There have been five recurrences of significant prolapse, and incontinence has developed i n 8 patients. Ninety-nine patients felt the outcome to be satisfactory or excellent. There were two major complications and one postoperativ e death. CONCLUSIONS: This teaching method has provided our residents a direct-view, hands-on familiarity with sacrospinous colpopexy while achieving results for the patients consistent with the outcomes oi oth er centers.