Le Fort Partial Colpocleisis: A Low-Cost Model

Introduction

As health care advances improve longevity, more women are entering the eighth and ninth decades of their life. It has been reported that 1 in 9 women will undergo surgery for incontinence or prolapse by age 80. ¹ Long-term recurrence rates from conventional reconstructive surgeries can be as high as 50% with a reoperation rate for failures as high as 30%.^1,2

First described by Gerardin in 1823, obliterative vaginal surgeries have long been used in the management of pelvic organ prolapse in elderly women who are no longer sexually active. It was not until 1877 that Leon Le Fort performed and published the technique for the procedure now known as Le Fort partial colpocleisis. This involves denudement of rectangles in the anterior and posterior vaginal walls which are then sutured together leaving lateral channels for drainage of cervical secretions. ¹ The surgery is performed leaving the uterus in place and is an excellent option for elderly patients with multiple medical issues who do not desire vaginal functionality and are not candidates for extensive reconstructive surgery. It can also be an option for recurrent pelvic organ prolapse in patients who are no longer sexually active. Typical success rates vary between 91% and 100% ³ and a recent review found recurrence rates as low as 4.2% with only 2% to 3% of patients requiring reoperation. ²

Although the procedure has been described extensively in text, new trainees may have a hard time comprehending the steps of the procedure through reading materials alone. Two-dimensional pictures are unable to capture the orientation of the prolapsed vagina which can be disorienting for the uninitiated. Previous models have described the technique for Le Fort as well as total colpectomy.^4,5 Although these models adequately describe the technique, they do not describe the proximal and distal aspects of the vagina in relation to the uterus or test for patency of vaginal tunnels. The video available below the making and use of a novel, low-cost simulation model to act as a learning aid for surgeons new to the technique of Le Fort partial colpocleisis.

Materials and Methods

To make our model, we purchased easily available craft supplies. This includes pink and magenta felt, an embroidery hoop, fusible bonding web (such as Stitch Witchery), as well as hook-and-loop fasteners. We used Black and White Velcro Sticky coins (4 pairs each) as well as Velcro sticky back tape. The cost of each model was under US $14 and time to make was approximately 1 hour (Figure 1).

OPEN IN VIEWER

Figure 1.

Completed simulation model.

Conclusions

The Le Fort partial colpocleisis technique has been in use for over a century and is an important tool in the versatility of management of pelvic organ prolapse. The advantages of our simulation model include its low cost and the use of easily available materials. Although this model has currently not been validated, we believe that this simple model will allow trainees to fully comprehend the steps of this procedure and have used it for this purpose in our community-based training program. This model is especially useful for orientation of the prolapsed vagina and understanding the basic steps and principal of the partial colpocleisis. Using this video, educators can construct a model and use it to orient trainees to the Le Fort partial colpocleisis procedure.