Laparoscopic Uterosacral Ligament Suspension with the Use of Barbed Suture

Abstract

Video Objective To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension Setting I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Interventions Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Conclusion Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity. To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity.