Robotic Nerve Sparing Uterosacral Ligament Suspension

Abstract

<h3>Study Objective</h3> To demonstrate a technique for robotic assisted nerve sparing uterosacral ligament suspension. <h3>Design</h3> Description and demonstration of a novel surgical technique. <h3>Setting</h3> Tertiary care academic center. <h3>Patients or Participants</h3> A 49-year-old woman, who presented with AUB -A, pelvic pain, and vaginal bulge, was diagnosed with stage 2 pelvic organ prolapse, adenomyosis and endometriosis. <h3>Interventions</h3> Robotic assisted hysterectomy and excision of endometriosis for treatment of her pelvic pain and AUB. Robotic approach was recommended for prolapse repair due to the other underlying conditions; however, decision was made to perform uterosacral suspension over mesh augmentation. Mobilization of the ureter and dissection of the inferior hypogastric nerve was performed. Suspension of the vaginal cuff was performed using barbed sutures. A total of 6 suspension sutures were placed incorporating the uterosacral ligaments to the anterior and posterior vaginal cuff. Obliteration of the enterocele was performed using this method. Care was taken not to include the inferior hypogastric nerve in these suspension sutures performing a nerve sparing uterosacral ligament suspension. <h3>Measurements and Main Results</h3> At 6 weeks, patient suffered no perioperative complications and had excellent apical suspension. Continued follow-up is ongoing. <h3>Conclusion</h3> Identification and avoidance of the inferior hypogastric nerve while performing uterosacral ligament suspension is a safe, feasible procedure and may prevent morbidities.