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Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy

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Abstract

Introduction and Hypothesis

Transvaginal ipsilateral uterosacral ligament colpopexy for pelvic organ prolapse (POP), which was reported by Shull et al. (Shull's colpopexy) in 2000, is one of the most frequently performed non-mesh pelvic floor reconstructive surgical procedures. Despite its excellent anatomical outcomes, ureteral injury and difficulty in uterosacral ligament detection (especially in patients with severe POP) are typical issues with this procedure.

Method

This video demonstrates the procedure in a 58-year-old woman, gravida 2 para 2, with POP-Q stage II uterine prolapse and stage I cystocele. At the beginning of the operation, the bilateral uterosacral ligaments were confirmed and separated from the ureters after entering the retroperitoneal space. The inferior hypogastric nerve and pelvic nerve plexus were also separated from the uterosacral ligament. After total laparoscopic hysterectomy, three ipsilateral delayed absorbable monofilament sutures were placed between the uterosacral ligament and the vaginal cuff. Retroperitonealization was then performed using a continuous suture with closure of the Douglas pouch.

Conclusion

Laparoscopic Shull’s colpopexy for POP is a secure procedure with the advantages of laparoscopy (magnification and sharing the operative field). This may become one of the most useful operations for apical support as native tissue repair.

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References

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan

    Kazuaki Nishimura, Kazuaki Yoshimura & Kaori Hoshino

  2. Japan, Obstetrics and Gynecology, University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan

    Toru Hachisuga

Authors
  1. Kazuaki Nishimura
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  2. Kazuaki Yoshimura
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  3. Kaori Hoshino
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  4. Toru Hachisuga
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Corresponding author

Correspondence to Kazuaki Yoshimura.

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Nishimura, K., Yoshimura, K., Hoshino, K. et al. Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy. Int Urogynecol J 28, 321–323 (2017). https://doi.org/10.1007/s00192-016-3137-y

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  • DOI: https://doi.org/10.1007/s00192-016-3137-y

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