Laparoscopic Uterine Suspension Research Articles

Colpoteres suspension procedure: an alternative Graft Colpopexy

Colpoteres suspension procedure: an alternative Graft Colpopexy

The New Operation Technique for Uterine Prolapse: Vaginally Assisted Laparoscopic Sacrohysteropexy (VALSH)

Laparoscopic uterine suspension techniques with its advantages of better visualization of pelvic anatomy, shorter hospitalization, favorable postoperative outcomes seem promising. The aim of this paper was to describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH).

Sling suspension: a new technique of treating uterine prolapse

To report a novel surgical technique of laparoscopic extraperitoneal sling suspension for uterine prolapse and evaluate its efficacy. A total of 21 consecutive patients of symptomatic uterovaginal prolapse with POP-Q (pelvic organ prolapse quantification system) stage ≥ 2 and aged 59 (42-76) years were enrolled for this procedure between September 2011 and December 2012. In brief, uterus was suspended to anterior abdominal wall fascia using an inelastic nonabsorable mesh extraperitoneally under laparoscopic guidance. The outcomes of interest included total operative duration, estimated blood loss, surgical length of stay POP-Q score change and quality of life questionnaire in pelvic floor distress inventor [PFDI-20] and pelvic floor impact questionnaire [PFIQ-7]. Follow-ups were scheduled at 1, 6 and 12 months and then annually. Comparisons were made between at preoperation and 6 and 12 months. The surgical success was defined as both subjective cure and significant improvement of POP-Q. This procedure was performed successfully in all patients. The estimated blood loss 10 (10-40) ml, operative duration 30 (25-90) minutes and postoperative hospital stay 1 (1-5) day. There were no major intraoperative or postoperative complications. The median follow-up was 20 (12-26) months. There were significant improvements in POP-Q measurements of Ba and C (P < 0.01) and quality-of-life scores (P < 0.01) at 6 and 12 months. The subjective cure rate was 100% and surgical success rate at 12 months 100%. This new sling suspension technique for uterine prolapse is safe, well-tolerated and effective so that it offers a simple alternative of laparoscopic uterine suspension.

Laparoscopic Uterine Suspension: The “Plication” Method

Laparoscopic Uterine Suspension is often used for uterine prolapse. Several different types of suspensions have been described over the years including those that incorporate mesh, suspended the round ligaments, plicate the round ligaments, plicate the uterosacral ligaments or any combination of all of these.

New procedures for uterine prolapse

Traditionally, vaginal hysterectomy and Manchester repair were the surgical approaches to treating uterine prolapse; however, both are associated with a relatively high subsequent vaginal vault recurrence. Laparoscopic uterine suspension is a new way of maintaining uterine support. Many women are keen to keep their uterus for a variety of reasons, including maintaining reproductive capability and the belief that the uterus, cervix, or both, may play a part of their gender identity. Non-removal of the uterus may retain functional (e.g. bowel, bladder and sexual) benefits. Therefore, the concept of uterine preservation for pelvic-organ prolapse has been of interest to pelvic-floor surgeons for many decades. In this review, we provide an overview of the available evidence on treating uterine prolapse surgically. We describe techniques to support the vault during hysterectomy, and examine the evidence for uterine-sparing surgery. Comparative outcomes for vaginal, abdominal and laparoscopic routes will be made.

Modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall: the easier way to treat uterine prolapse

To report the outcomes of modified laparoscopic extraperitoneal uterine suspension to anterior abdominal wall for uterine prolapse using mesh. Twenty-two patients with uterovaginal prolapse, stage 2 or greater according to pelvic organ prolapse quantification (POP-Q), and with desire for uterine preservation, underwent modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall bilaterally using mesh. The outcomes were measured by POP-Q and quality-of-life questionnaires. Intraoperative or postoperative complications were also observed. Patient age was 61.4 ± 12 years, and parity was 3.3 ± 1.8. After surgery, there was significant improvement in POP-Q measurements of Ba, Bp, and C (P < 0.001). The objective cure rate at 1 year was 100%. A significant improvement in quality-of-life scores was observed (P < 0.001). There were no major intraoperative or postoperative complications. However, all patients reported postoperative dragging pain at the points of puncture ports where the mesh was fixed to the abdominal wall. The visual analog scale decreased from a mean 3-day score of 2.9-0 at 1-month follow-up. Modified laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall using mesh is a feasible and effective method for treating uterine prolapse and is easy to perform.

Laparoscopic High Uterosacral Ligament Uterine Suspension for the Treatment of Uterine Prolapse in Young Patients: Analysis of 11 Cases

Laparoscopic High Uterosacral Ligament Uterine Suspension for the Treatment of Uterine Prolapse in Young Patients: Analysis of 11 Cases

A new laparoscopic technique for uterine prolapse: one-sided uterine fixation through the round ligament

In this study, we provide a description of laparoscopic uterine suspension technique through round ligament. From 1997 to 2010, 55 patients with uterine prolapse were treated by laparoscopic uterine suspension. It is performed by suturing and tying a 1-0 Ethibond on the left round ligament at its insertion into the uterus. Then curved forceps pass the lateral puncture wound into the extraperitoneal space along the round ligament and penetrates the anterior leaf of the broad ligament into the peritoneal cavity and grasps the free ends of the Ethibond. They are withdrawn extraperitoneally along the round ligament then tightly tied at the fasciae on either side of the lateral puncture wound. Forty-two out of 55 patients (76.4%) experienced a reduction of prolapse to stage 0, regardless of what stage they started from. Twelve out of 55 (21.8%) experienced a reduction of prolapse varying from one to two stages. One out of 55 (1.8%) experienced no reduction in prolapse. This technique reconstructs a new, inelastic round ligament.

Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

The surgical management of uterine prolapse in women who wish to retain their uterus remains a challenge. Several techniques have been reported using open abdominal, laparoscopic and vaginal approaches. The laparoscopic approach offers both excellent intraoperative visualisation of supportive and adjacent structures and quick postoperative recovery. Currently, laparoscopic suspension of the uterus to the round ligaments, uterosacral ligaments, suture and synthetic mesh suspension to the sacral promontory have been reported. This report describes a new surgical technique of laparoscopic uterine suspension, which has been performed successfully in eight women. Mersilene tape is used to suspend the uterus to the sacral promontory bilaterally and to recreate new uterosacral ligaments.

Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

Authors response to: Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

Authors response to: Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

427: Transobturator Cystocele Repair With Mesh in Conjunction with Laparoscopic Uterine Suspension (Sacrohysteropexy)

To demonstrate the anatomy and surgical technique of mesh from above (laparoscopically) and below (vaginally) for recurrent cystocele in conjunction with uterine prolapse. We present a minimally invasive alternative to hysterectomy with complete reconstruction with the technique of cystocele repair with anterior wall mesh via a transobturator approach vaginally (Perigee procedure) combined with a laparoscopic uterine suspension with mesh sacral-uteropexy. Utilizing this approach, the cystocele, anterior apical enterocele, uterine prolapse and high rectocele are treated with a procedure that is minimally invasive, restores normal anatomy and avoids the need for hysterectomy.

Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

The surgical management of uterine prolapse in women who wish to retain their uterus remains a challenge. Several techniques have been reported using open abdominal, laparoscopic and vaginal approaches. The laparoscopic approach offers both excellent intraoperative visualisation of supportive and adjacent structures and quick postoperative recovery. Currently, laparoscopic suspension of the uterus to the round ligaments, uterosacral ligaments, suture and synthetic mesh suspension to the sacral promontory have been reported. This report describes a new surgical technique of laparoscopic uterine suspension, which has been performed successfully in eight women. Mersilene tape is used to suspend the uterus to the sacral promontory bilaterally and to recreate new uterosacral ligaments.

Pregnancy after laparoscopic uterine suspension for the treatment of dyspareunia caused by a retroverted and retroflexed uterus

This is a case study of a 27-year-old woman suffering from severe dyspareunia because of a severely retroverted and retroflexed uterus. The pain was affecting her quality of life and marriage. Laparoscopic uterine suspension with the UPLIFT procedure was performed leading to resolution of pain with intercourse. The patient subsequently became pregnant and delivered vaginally. Postpartum physical examination revealed a well-suspended uterus still in an anteverted, anteflexed position.

Laparoscopic uterosacral uterine suspension: A minimally invasive technique for treating pelvic organ prolapse

Laparoscopic uterosacral uterine suspension: A minimally invasive technique for treating pelvic organ prolapse

Laparoscopic uterosacral uterine suspension: A minimally invasive technique for treating pelvic organ prolapse

Study Objective To assess the surgical outcomes of laparoscopic uterosacral uterine suspension and describe the surgical technique. Design Retrospective chart review (Canadian Task Force classification II-3). Setting University tertiary medical center. Patients Twenty-three patients with symptomatic uterine prolapse and desire for uterine preservation who underwent surgical repair. Intervention Laparoscopic uterine uterosacral uterine suspension. Measurements Preoperative and postoperative evaluations were completed. The stage of pelvic organ prolapse was assessed using the ICS pelvic organ prolapse quantification (POP-Q) examination. Descriptive statistics and paired t testing were used for statistical analysis. Results Nineteen of 23 patients (82.6%) had preoperative prolapse stage 2 or greater. Nine patients (40.9%) had uterine prolapse beyond the hymen. After operation there were significant improvements in the stage of prolapse (2 vs 0, p < .01). The POP-Q scores for point C and D were significantly further away from the hymen after operation than compared with the preoperative values (−0.6 vs −7.8, and −5.0 vs −8.6; p < .01) respectively. There were no intraoperative complications. The estimated blood loss (mean ± SD) was 111.5 ± 139.4 mL. The hospital stay (mean ± SD) was 2.2 ± 1.7 days. None of the patients had symptomatic prolapse during the mean follow-up of 15.9 months. Conclusion Laparoscopic uterine suspension appears to be a safe and effective treatment option for uterine prolapse in patients who desire uterine preservation.

Laparoscopic Uterine Suspension in Patients With Cervical Elongation

The objective of this study was to describe an alternative technique to the Manchester procedure for uterine suspension of a uterus with an elongated cervix, which is applicable for patients undergoing laparoscopic repair of multiple pelvic floor defects. This study consisted of a retrospective review of 2 patients who underwent vaginal trachelectomy combined with laparoscopic uterine suspension using a high uterosacral fixation technique. Two patients with stage II prolapse of an elongated cervix, each of whom desired conservation of her uterus, underwent transvaginal partial trachelectomy combined with a laparoscopic suspension of the uterus using a high uterosacral fixation technique. They then underwent concomitant laparoscopic paravaginal repair, antiincontinence surgery, and posterior repair. No intraoperative complications were noted. The patients were discharged within 24 hours. In patients undergoing laparoscopic repair of multiple pelvic floor defects, and who have protrusion of an elongated cervix, transvaginal partial trachelectomy combined with laparoscopic uterine suspension is a safe and effective alternative to the Manchester procedure.

A review of laparoscopic uterine suspension procedures for uterine preservation

The most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. Uterine suspension procedures can be performed abdominally, vaginally, or laparoscopically. This article focuses on the three different laparoscopic approaches of uterine suspension for uterine preservation: suspension to the round ligaments; suspension to the uterosacral ligaments; and suspension to the anterior ligament of the sacral promontory. This article reviews the published studies in the literature, analyzes the results, discusses the differences, and compares the different laparoscopic techniques. A review of the literature reveals a paucity of research studies and publications on laparoscopic uterine suspension procedures. All the published studies are small, retrospective case series or case studies. Laparoscopic ventrosuspension using the round ligaments for uterine prolapse has a reported success rate of less than 50%. The ventrosuspension procedure has a very limited role and should not be employed. In comparison, laparoscopic uterine suspension procedures have a reported success rate ranging between 81 and 100%. The newest surgical technique is the laparoscopic sacral colpohysteropexy and there is only one reported case series on this procedure. The reported success rate for the sacral colpohysteropexy is 100%. The first surgical option for uterine preservation is uterine suspension to the uterosacral ligaments. If the uterosacral ligaments cannot be identified or the uterosacral ligaments are weak and unusable, then laparoscopic sacral colpohysteropexy is a reliable second option. Uterine suspension to the round ligaments has an unacceptably high failure rate and is not an effective, durable alternative.

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This study was undertaken for four purposes. The first was to further explore surgical correction rates for uterovaginal prolapse utilizing uterosacral ligaments. The second was to compare the efficacy of correction by this method via both transvaginal and laparoscopic routes. The third was to assess and compare postoperative quality of life issues between the two groups. Our last goal was to introduce the novel approach of laparoscopic uterine suspension in situ. One hundred sixty-three women were included in a retrospective cohort study. All women underwent surgical correction of their symptomatic vaginal or uterine prolapse utilizing uterosacral ligaments in conjunction with other pelvic reconstruction procedures between 1994 and 1998. Patients were examined to assess anatomic cure at least one year after surgery and sent a questionnaire to assess quality of life issues at least 6 months after surgery (range 6–48, mean 21 months). Further follow-up at 6–10 years was done and results are noted. Urogynecology and advanced pelvic surgery teaching hospital. One hundred sixty-three women with vaginal or uterine prolapse underwent pelvic reconstruction. Uterosacral ligament suspension was utilized for the correction of uterovaginal prolapse. This goal was accomplished either by laparoscopy or by vaginal approach. Surgical correction of Level I support was found on all patients in both groups. Surgical breakdown of Level II support necessitating additional surgery was found on 5% of both groups at the earlier review. Total immediate postoperative complications were similar in all groups, as was postoperative morbidity. There was no statistically significant difference between the groups with regards to both quality of life issues and perception of surgical success, with marked improvement in all groups. It is interesting to note that there was a statistically significant finding linking tobacco abuse with surgical failure. The 6–10 year data shows a fall-off of success to 91%. A complete statistical analysis of success with POPQ points and QOL evaluation will be presented. This study lends significant support to earlier work relating success of suspending the vaginal vault utilizing uterosacral ligaments. This study also indicates that vaginal vault suspension can be safely and effectively accomplished via both vaginal and laparoscopic routes, with effective in situ uterine suspension by laparoscopy. There is a fall-off of success associated with the site specific repairs with in situ patient’s fascial supports over time which may leave some room for use of graft materials. Patient satisfaction and marked improvement in quality of life result from correction of pelvic prolapse utilizing uterosacral ligaments.

Laparoscopic uterosacral vault or uterine suspension: Our experience

Laparoscopic uterosacral vault or uterine suspension: Our experience