Skip to main content
SpringerLink
Log in

Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure

  • IUJ Video
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hyposthesis

The uterosacral ligament (USL) is the main structure of physiological apical support, and USL suspension is one of the most commonly used methods for native tissue apical suspension. Structures surrounding the USL are complex, and the USL itself is difficult to identify, especially the sacral portion of the USL. Laparoscopy improves visualization, but exposure of the USL is still unsatisfactory.

Methods

In this study, we report a simple method for exposing and suturing the USL laparoscopically, with step-by-step instructions, well-presented figures and videos. The key techniques are shown as follows: keeping tension on the USL with a uterine manipulator, dissecting the space medial to the USL, exposing the portion of the USL near the sacrum through the natural space, and then suturing it medially and connecting it directly to the posterior cervix.

Results

95 consecutive patients have undergone this modified USLS and none had serious perioperative complication.

Conclusion

In this way, the USL anatomy is exposed well, which may make placement of sutures in USL suspension safe and effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311:1023–34. https://doi.org/10.1001/jama.2014.1719.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Nager CW, Visco AG, Richter HE, Rardin CR, Rogers RG, Harvie HS, et al. Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial. JAMA. 2019;322:1054–65. https://doi.org/10.1001/jama.2019.12812.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ripperda CM, Jackson LA, Phelan JN, Carrick KS, Corton MM. Anatomic relationships of the pelvic autonomic nervous system in female cadavers: clinical applications to pelvic surgery. Am J Obstet Gynecol. 2017;216:388.e1–7. https://doi.org/10.1016/j.ajog.2016.12.002.

    Article  Google Scholar 

  4. Buller JL, Thompson JR, Cundiff GW, Krueger Sullivan L, Schön Ybarra MA, Bent AE. Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol. 2001;97:873–9. https://doi.org/10.1016/s0029-7844(01)01346-1.

    Article  PubMed  CAS  Google Scholar 

  5. Umek WH, Morgan DM, Ashton-Miller JA, DeLancey JO. Quantitative analysis of uterosacral ligament origin and insertion points by magnetic resonance imaging. Obstet Gynecol. 2004;103:447–51. https://doi.org/10.1097/01.AOG.0000113104.22887.cd.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank to Dr. C.Y. Liu, the former chairman of American Association of Gynecologic Laparoscopists, for his helpful guidance that improved our anatomical understanding of pelvic floor reconstruction.

We thank Mr. Zhou, Yuyun, an excellent architect who helped us improve the appearance of the figures.

Author information

Authors and Affiliations

  1. Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, 1st Xueshi Road, Hangzhou, Zhejiang, People’s Republic of China, 310006

    Yinluan OuYang, Fan Li & Xiaofeng Zhao

  2. The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China

    Wanwan Xu & Rui Wang

Authors
  1. Yinluan OuYang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wanwan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaofeng Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Xiaofeng Zhao contributed to the study conception and study design, reviewed and approved the final manuscript. Yinluan OuYang contributed to conception, design, methodology, analysis, acquisition of data and writing-original draft. Wanwan Xu, Fan Li and Rui Wang contributed to methodology, analysis and acquisition of data.

Corresponding author

Correspondence to Xiaofeng Zhao.

Ethics declarations

Details of ethics approval

The study is part of an ongoing prospective study (ChiCTR1900025507) and has been approved by the Ethics Committee of The Fourth Affiliated Hospital Zhejiang University School of Medicine (06/18/2019, no. K20190038). All patients signed written informed consent for the surgical procedure and use of individual data for research.

Consent

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

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Laparoscopic uterosacral ligament suspension with uterus preservation (MP4 96451 kb)

Laparoscopic uterosacral ligament suspension with hysterectomy (MP4 106156 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

OuYang, Y., Xu, W., Li, F. et al. Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure. Int Urogynecol J 33, 3587–3590 (2022). https://doi.org/10.1007/s00192-022-05257-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-022-05257-8

Keywords

Search

Navigation