Laparoscopic Uterosacral Ligament Suspension

Below we describe the laparoscopic modification by Trifyllis of the classic vaginal uterosacral ligament suspension.

Indication

  • Uterine prolapse.
Tying the knot on the right side.
Tying the knot on the left side. Notice the elevation of the vaginal cuff.

Contraindications

  • Obliteration of the pouch of Douglas.

Complications

  • Ureteral injury or kinking and consequent hydronephrosis between 1.8% and 10.9% in international bibliography concerning the vaginal route. We estimate that this rate can be significantly lower with this laparoscopic technique.
  • Prolapse recurrence.

Postoperative Management

  • Nephrosonography for possible hydronephrosis. In case of hydronephrosis the ipsilateral suture has to be extracted.

Bibliography

  • Aydin, C, Mercimek, MN. Laparoscopic management of bladder injury during total laparoscopic hysterectomy. Int J Clin Pract. 2020; 00:e13507. https://doi.org/10.1111/ijcp.13507
  • Manodoro, S., Frigerio, M., Milani, R. et al. Tips and tricks for uterosacral ligament suspension: how to avoid ureteral injury. Int Urogynecol J 29, 161–163 (2018). https://doi.org/10.1007/s00192-017-3497-y
  • Panico, G., Campagna, G., Caramazza, D. et al. Laparoscopic high uterosacral ligament suspension: an alternative route for a traditional technique. Int Urogynecol J 29, 1227–1229 (2018). https://doi.org/10.1007/s00192-018-3588-4
  • Siff, Lauren N. MD; Jallad, Karl MD; Hickman, Lisa C. MD; Walters, Mark D. MD Surgical Anatomy of the Uterosacral Ligament Colpopexy, Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 – Volume 24 – Issue 5 – p 380-382 doi: 10.1097/SPV.0000000000000461

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