this is a medical professional presentation

1. VaginalParaVaginalRepair (VPVR) Anterior vaginal prolapse repair Using a side specific technique and bolstering repair with SurgiSIS Andri Nieuwoudt Terneuzen www.nieuwoudt.nl

2. Matthew Barber John DeLancey

3. Ischial spine Paravaginal defect

5. www.nieuwoudt.nl

6. www.nieuwoudt.nl Left paravaginal defect

7. cervix Obturator internus fascia (ATFP) Pubic rami Symphasis pubis Ischial spines

8. Effect of Plication on paravaginal defect

11. Pull direction in prolapse

12. Correcting the mechanical deffect

13. Ti-Cron Vicryl Placing sutures

14. Ti-Cron Vicryl Side-specific Repair (using the same sutures)

15. Ti-Cron Vicryl Sutures anchoring SurgiSIS

16. Biomesh collagen ingrowth Bolstering with SIS after suturing vesico vaginal septum to sidewall

17. Biomesh collagen ingrowth Correcting the collagen deffect by bridging with SIS

21. bladder Paravaginal disection

22. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

23. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

24. Cauterization of veins With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

25. 3. Sweep Bladder (& Ureter) medially 3. Stroop blaas en urineleider na binnen ( weg van de bekkenzijwand) With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

26. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

27. www.nieuwoudt.nl Left paravaginal defect

28. 4. Place 4 pairs of stay sutures in Whiteline or Obturator membrane 4. 4 hechtingen paren worden door whiteline of binnen membraan van bekkenwand geplaatst With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

29. Ti-Cron Vicryl Placing sutures

31. Cervix Symphysis Whiteline Sutures baarmoederhals schaambeen With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

32. Placing of sutures on left ATFP Dubble needle holder technique www.nieuwoudt.nl

33. Deep stich 1 www.nieuwoudt.nl

34. Deep stich 2 (Ischial spine) www.nieuwoudt.nl

35. “ superficial “ 1 (bladder neck) www.nieuwoudt.nl

36. Pubo Urethral Ligament ( cat’s claw) www.nieuwoudt.nl

37. Placing suture on edge of Vesico vaginal seprum www.nieuwoudt.nl

38. Incorporating the vesico-vaginal fascia/ septum www.nieuwoudt.nl

39. Suture running from ATPF through Vesico-vaginal adventitia Deepstich 2 ( ischial spine) Deep stich 1 ( bladder base) www.nieuwoudt.nl

40. Bladder wall pulled back in position when knots are tied Tying bladder to White line www.nieuwoudt.nl

41. Inf border of septum High Transverse Defect (HTD) www.nieuwoudt.nl HTD

42. Closed HTD www.nieuwoudt.nl

43. www.nieuwoudt.nl before Side specific repair

44. www.nieuwoudt.nl Site specific repair(HTD)

45. before after www.nieuwoudt.nl

46. Bolstering with SurgiSIS www.nieuwoudt.nl

47. Baie Dankie Thanking you www.nieuwoudt.nl

48. Anyone interested to learn the Vaginal Side Specific Repair can contact the webmaster