Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach
- 174 Downloads
Introduction and hypothesis
To compare laparoscopic and vaginal approaches to uterosacral ligament vault suspension (USLS) by perioperative data, short-term complications, rates of successful concomitant adnexal surgery and procedural efficacy.
Retrospective cohort of USLS procedures performed at the time of hysterectomy at a tertiary care center over a 3-year period. Patient demographics, surgical data, concomitant adnexal procedures and complications were abstracted from a surgical database and compared using parametric or non-parametric tests as appropriate. Validated questionnaires (POPDI-6, UDI-6, PROMIS) were used to collect information on recurrence and long-term complications. Patients were analyzed according to both intention-to-treat analysis based on the intended approach and the completed route of surgery to deal with intraoperative conversions.
Two hundred six patients met the criteria for inclusion; 152 underwent vaginal USLS (V-USLS) and 54 laparoscopic USLS (L-USLS). No statistically significant differences in mean case time, postoperative length of stay or perioperative infection were found. While no ureteric obstructions occurred in the L-USLS group, in the V-USLS group 14 (9%) obstructions occurred (p = 0.023). Postoperative urinary retention was higher with V-USLS (31% vs. 15%, p = 0.024). Rates of successfully completed adnexal surgery differed (56% vs. 98%, p < 0.001) in favor of L-USLS. Patient-reported symptomatic recurrence of prolapse was higher in the V-USLS group (41% vs. 24%, p = 0.046); despite this, re-treatment did not differ between the groups (0% vs. 7%, p = 0.113).
Perioperative case time and complications did not differ between approaches. However, rates of completed adnexal surgery were significantly higher in the laparoscopic group, which could influence surgical decisions concerning approaches to prolapse surgery.
KeywordsPelvic organ prolapse Uterosacral ligament suspension Vaginal surgery Laparoscopic surgery Sacrospinous ligament suspension Complications
Sacrospinous ligament fixation
Uterosacral ligament suspension
Vaginal uterosacral ligament vault suspension
Laparoscopic uterosacral ligament vault suspension
Uterosacral vault suspension
Body mass index
American Society of Anaesthesiology
Pelvic organ prolapse quantification system
Estimated blood loss
Length of stay
6-Question Pelvic Organ Prolapse Distress Inventory
- NIH PROMIS SexFS
National Institutes of Health’s Patient-Reported Outcomes Measurement Information System sexual function questionnaire
Urinary Distress Inventory
Pelvic organ prolapse
Urinary tract infection
Opportunistic bilateral salpingectomy
Epithelial ovarian cancer
Total vaginal length
This study was funded by the Department of Obstetrics and Gynecology DEAR/Leadership Circle Fund, University of Calgary.
Compliance with ethical standards
Conflicts of interest
Erin Brennand has received grant-in-aid funding for investigator-initiated research from Boston Scientific and Contura International. Colin Birch has accepted paid travel expenses and speaker honoraria from Boston Scientific. Sara Houlihan, Shunaha Kim-Fine and Selphee Tang have no declarations.
- 4.Brubaker L, Glazener C, Jacquetin B, Maher C, Melgrem A, Norton P, et al. Surgery for pelvic organ prolapse. In: Abrams P, Cordozo L, Koury S, Wein A, editors. 4th international consultation on incontinence. Paris: Health Publication Ltd; 2009. p. 1278.Google Scholar
- 9.Jelovsek JE, Barber MD, Brubaker L, et al. Effect of uterosacral ligament suspension vs sacrospionous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the optimal trial randomized clinical trial. JAMA. 2018;319(15):1554–65.CrossRefGoogle Scholar
- 10.Rardin CR, Erekson EA, Sung VW, Ward RM, Myers DL. Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches. J Reprod Med. 2009;54(5):273–80.Google Scholar