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McCall Culdoplasty during Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial.
Sara R Till1, Kumari A Hobbs2, Janelle K Moulder3
1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Journal of Minimally Invasive Gynecology
|November 13, 2017
Summary
McCall culdoplasty is a safe and feasible addition to total laparoscopic hysterectomy, showing no increased operative time, blood loss, or complications. This procedure did not negatively impact vaginal length, apex support, or sexual function at 12 months.
Area of Science:
- Gynecology
- Minimally Invasive Surgery
- Urogynecology
Background:
- Total laparoscopic hysterectomy (TLH) is a common procedure for benign gynecological conditions.
- Cuff closure technique after hysterectomy can influence vaginal vault support and prolapse risk.
- McCall culdoplasty is known to reduce apical prolapse risk during vaginal hysterectomy.
Purpose of the Study:
- To assess the feasibility and safety of performing McCall culdoplasty concurrently with TLH.
- To compare vaginal length, apex support during Valsalva, and sexual function at 12 months post-TLH between McCall culdoplasty and standard cuff closure.
- To evaluate operative time, blood loss, and complications associated with the combined procedure.
Main Methods:
- A pilot randomized controlled trial (RCT) was conducted with 50 women undergoing TLH for benign indications.
- Participants were randomized (1:1) to either McCall culdoplasty plus standard cuff closure or standard cuff closure alone.
- Pelvic Organ Prolapse Quantification and Female Sexual Function Index were used preoperatively and at 6 and 12 months postoperatively.
Main Results:
- No significant differences were observed in operative time, estimated blood loss, or complication rates between the two groups.
- At 12 months, total vaginal length, vaginal apex support during Valsalva, and sexual function (including dyspareunia) did not differ between the McCall culdoplasty and standard closure groups.
- Follow-up loss was similar in both groups, indicating comparable patient retention.
Conclusions:
- Adding McCall culdoplasty to TLH is feasible and safe, without increasing operative time, blood loss, or complications.
- The procedure did not adversely affect vaginal length, apex support, or sexual function at 12 months post-surgery.
- McCall culdoplasty may be a valuable adjunct to TLH for potentially preventing apical prolapse, similar to its established role in vaginal hysterectomy.