Laparoscopic uterosacral ligaments plication for the treatment of uterine prolapse

Abstract

To present preliminary results of a simple, minimally interventional, uterus-sparing procedure for uterine prolapse repair. This prospective study was undertaken on women with symptomatic uterine prolapse >/=2nd stage, who declined hysterectomy at the time of prolapse surgery. A 10 mm laparoscope and three 5 mm ancillary trocars were used to perform the procedure. The uterosacral ligament was invested with a nonabsorbable suture. A total of three helical type sutures were placed full-thickness in the uterosacral ligament, beginning in the distal third of the ligament. The ends of the suture were tied with an extra-corporeal knot-tying technique on each side, thus shortening the ligaments. Finally, the round ligaments were plicated to restore the uterus to its correct anatomic position. No additional surgical procedure was performed concomitantly. Ten patients underwent laparoscopic uterosacral ligaments plication for the treatment of symptomatic uterine prolapse. The median (range) patients age was 45.5 years (36-66). Five (50%) patients were premenopausal and 3 (60%) had not completed their family. The median operating time was 22.5 min (20-45). No intraoperative complications occurred. The median follow-up time was 21 months (range 15-33). The median postoperative difference in POP-Q point C was -3 cm (range 0 to -5). Eight (80%) patients were objectively cured at the last follow-up evaluation and all of them reported a complete resolution of their symptoms. Two women had prolapse recurrence and underwent vaginal hysterectomy 7 and 24 months after primary surgery, respectively. Laparoscopic uterosacral ligaments plication is a minimally invasive and straightforward simple procedure that appears to be a safe and effective treatment option for women with uterovaginal prolapse who desire uterine preservation.