8097 How Do You Do It? a Survey on the Preferences of Surgeons Regarding Uterosacral Ligament Suspension (USLS) Technique

Abstract

<h3>Study Objective</h3> To describe the practice patterns and techniques for performing uterosacral ligament suspension (USLS) for the treatment of apical prolapse. <h3>Design</h3> Web-based survey performed from October 2021 to April 2022. Study was IRB exempt. Data was collected in RedCap. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Members of AUGS, IUGA, AAGL, and UGSA. <h3>Interventions</h3> A 31-item, deidentified questionnaire. <h3>Measurements and Main Results</h3> We received a total of 595 responses, mostly from the United States (40.7%) and Australia (7.9%). Most of the respondents were Obstetrics and Gynecology and FPMRS specialists (67.9%), followed by general Obstetrics and Gynecology (16.8%) and MIGS (8.4%). Most surgeons were more than 20 years in practice (33.9%) and 49% perform >100 surgeries/year with a mean of 67.7% of cases being for apical support procedures. USLS is the most common apical support surgery taught during their fellowship (44.4%), followed by sacrospinous ligament suspension - SSLS (35.8%) and sacrocolpopexy - SCP (19.9%). Regarding preferences, USLS is performed by 46.3% of respondents >40% of the time for apical support, while 29.1% and 20.1% perform SSLS and SCP, respectively. Vaginal route (72.8% > 60% time) and ipsilateral (64.3%) high USLS technique were the most common route and technique performed. When placing sutures vaginally, 32.3% of respondents used delayed absorbable suture, followed by 24.3% absorbable sutures. Two sutures were the most common choice for ipsilateral or midline USLS plication. There was even distribution between placing sutures at the level of the ischial spine (46.6%) or above the level of the ischial spine (36.4%). A third of surgeons that perform lap/robotic/open USLS perform a relaxing peritoneal incision. Eighteen percent of surgeons routinely identify the inferior hypogastric plexus. Routine cystoscopy is performed by 65.2% and 73.2% of surgeons that perform, respectively, lap/robotic/open and vaginal USLS. <h3>Conclusion</h3> There is significant heterogeneity in the techniques to perform a uterosacral ligament suspension for apical prolapse. Standardization is recommended for future surgical studies.