Laparoscopic Uterosacral Ligament Suspension Research Articles

Meta-analysis of the efficacy of laparoscopic uterosacral ligament suspension in patients with pelvic organ prolapse

ObjectiveThis study aimed to evaluate the efficacy of laparoscopic uterosacral ligament suspension (LUSLS) for pelvic organ prolapse (POP) using a meta-analysis method. MethodsAll articles about LUSLS published in English from Jan. 2010 to Jan. 2020 were retrieved using a computer from search engines, including PubMed, EMbase, Cochrane Library, CNKI, Wanfang, VIP, and Chinese Medical Journals. Meta-analysis was performed by two evaluators using RevMan 5.3 software according to the inclusion criteria. ResultsA total of five studies were finally included, with 361 LUSLS cases and 361 control cases. LUSLS group showed a shorter operation duration (SMD-1.96; 95% CI = −3.90- −0.03; P = 0.05), more POP-quantification system (Q) (I) (SMD1.64; 95% CI = 1.05–2.56; P = 0.03), than the control group, with significant differences. There was no difference in the complication incidence, hospital stay, POP-Q>=II between the 2 groups (P > 0.05). ConclusionLUSLS was a safe and effective treatment for POP. Patients had higher postoperative satisfaction, shorter operation duration and satisfactory outcome. More high-quality randomized controlled trials are required in the future to make the results of the meta-analysis more accurate.

Laparoscopic uterosacral ligament suspension: a systematic review and meta-analysis of safety and durability.

Pelvic organ prolapse (POP) is a widespread condition affecting from 40% to 60% of women. Reconstructive vaginal surgeries are the most commonly performed procedures to treat POP. Among those, uterosacral ligament suspension (USLS), which is usually performed transvaginally, preserves pelvic statics and dynamics and appears to be an effective method. Laparoscopic USLS is a valid alternative to vaginal approach, and the aim of our review is to confirm its safety and feasibility and to compare clinical outcomes among the procedures. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed and Scopus databases in December 2022. We made no restriction on the publication year nor on the country. Data about POP-Q recurrence rate (RR), intraoperative and postoperative complications (graded according to Clavien-Dindo classification), readmission rate, and reoperation rate were collected and analyzed. We used comparative studies for meta-analysis. A total of nine studies fulfilled inclusion criteria: two articles were non-comparative retrospective observational studies, three more articles were comparative studies where laparoscopic USLS was confronted with other surgical techniques (only data of laparoscopic USLS were analyzed), and four were comparative retrospective cohort studies between laparoscopic and vaginal USLS procedures. The comparative studies were enrolled in meta-analysis. Patients were analyzed concerning perioperative risks and the risk of recurrence. The meta-analysis highlighted that there was no clear inferiority of one technique over the other. Laparoscopic USLS is a technique with a low complication rate and low recurrence rate. Indeed, laparoscopic procedure allows better identification of anatomical landmarks and access to retroperitoneum. Moreover, efficacy over time and durability of Laparoscopic (LPS) USLS was also observed. However, these data should be weighed in light of the length of follow-up, which was in a very short range. Further, focused and prospective studies will be necessary to confirm this finding.

The effectiveness and safety of laparoscopic uterosacral ligament suspension: a systematic review and meta-analysis.

Laparoscopic uterosacral ligament suspension (LUSLS) is a technique to correct apical pelvic organ prolapse (POP) by shortening the uterosacral ligaments with sutures. A systematic review with meta-analysis of the effectiveness and safety of LUSLS as treatment for apical POP. PubMed and Cochrane search using 'pelvic organ prolapse', 'laparoscopy' and 'uterosacral', including synonyms. All articles in English presenting outcome of an original series of women with LUSLS as treatment of apical POP. Case reports were excluded. Study enrollment was performed by two reviewers. Our primary outcome measures were objective and subjective effectiveness of the procedure. Secondary outcome measures regarded complications and recurrence. Bias was assessed with the Newcastle Ottawa Scale. Of 138 hits, 13 studies were included with 933 LUSLS patients. The average follow-up was 22 months. All were nonrandomised cohort studies. The pooled anatomic success rate is 90% for all LUSLS procedures (95% confidence interval [CI] 83.3-95.5). LUSLS with hysterectomy resulted in an anatomic success rate of 96.6% (95% CI 87.5-100) and LUSLS with uterus preservation 83.4% (95% CI 67.7-94.6). The pooled subjective cure rate was 90.5% (95% CI 81.9-96.5). The rate of major complications was 1%. Laparoscopic uterosacral ligament suspension (with or without uterus preservation) seems to be an effective and safe treatment for women with apical POP, but long-term prospective trials and randomised controlled trials are necessary to confirm these findings.

Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure.

The uterosacral ligament (USL) is the main structure of physiological apical support, and USL suspension is one of the most commonly used methods for native tissue apical suspension. Structures surrounding the USL are complex, and the USL itself is difficult to identify, especially the sacral portion of the USL. Laparoscopy improves visualization, but exposure of the USL is still unsatisfactory. In this study, we report a simple method for exposing and suturing the USL laparoscopically, with step-by-step instructions, well-presented figures and videos. The key techniques are shown as follows: keeping tension on the USL with a uterine manipulator, dissecting the space medial to the USL, exposing the portion of the USL near the sacrum through the natural space, and then suturing it medially and connecting it directly to the posterior cervix. 95 consecutive patients have undergone this modified USLSand none had serious perioperative complication. In this way, the USL anatomy is exposed well, which may make placement of sutures in USL suspension safe and effective.

Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study.

IntroductionLaparoscopic sacral colpopexy is the gold standard technique for apical prolapse correction but it is a technically challenging procedure with rare but severe morbidity. Laparoscopic high uterosacral ligament suspension could be a valid technically easier alternative using native tissue.Material and MethodsIn the period from 2015 to 2018, 600 women were submitted to laparoscopic sacral colpopexy while 150 to laparoscopic high uterosacral ligament suspension in three Italian urogynecology referral centers. We enrolled women with apical prolapse stage ≥2 alone or multicompartment descensus. To reduce allocation bias, we performed a propensity matched analysis. Women undergoing laparoscopic high uterosacral ligament suspension surgery were matched 1:2 to women undergoing laparoscopic sacral colpopexy. The cumulative proportion of relapse-free women in time was analyzed by the Kaplan–Meier method. The primary objective of this multicenter case-control retrospective study was to compare the recurrence rate while the secondary objectives were to compare feasibility, safety, and efficacy of laparoscopic sacral colpopexy and laparoscopic high uterosacral ligament suspension in surgical treatment of pelvic organ prolapse.ResultsThree hundred and nine women were enrolled (103 laparoscopic high uterosacral ligament suspension; 206 laparoscopic sacral colpopexy). Median operatory time was significantly shorter in the laparoscopic high uterosacral ligament suspension group (P = 0.0001). No statistically significative difference was found in terms of estimated blood loss, admission time, intraoperative, and major early postoperative complications, postoperative pelvic pain, dyspareunia and de novo stress urinary incontinence. Surgical approach was the only independent risk factor for prolapse recurrence (RR = 6.013 [2.965–12.193], P = 0.0001). The objective cure rate was higher in the laparoscopic sacral colpopexy group (93.7 vs. 68%, 193/206 vs. 70/103, P = 0.0001) with a highly reduced risk of recurrence (RR = 5.430 [1.660–17.765]). Median follow up was 22 months.ConclusionBoth techniques are safe, feasible, and effective. Laparoscopic sacral colpopexy remains the best choice in treatment of multicompartment and advanced pelvic organ prolapse while laparoscopic high uterosacral ligament suspension could be appropriate for moderate and isolated apical prolapse when laparoscopic sacral colpopexy is not suitable for the patient or to prevent prolapse in women at high risk at the time of the hysterectomy.

Comparison of laparoscopic high and vaginal uterosacral ligament suspension in the management of apical prolapse

Comparison of laparoscopic high and vaginal uterosacral ligament suspension in the management of apical prolapse

Risk factors of lower urinary tract injury with laparoscopic sacrocolpopexy

BACKGROUNDLower urinary tract injuries can occur during pelvic reconstructive surgery, including sacrocolpopexy. The reported injury rates range from 0.4% to 10.6% with laparoscopic sacrocolpopexy, 1.1% to 3.3% with abdominal sacrocolpopexy, and 2.3% to 10% with robotic sacrocolpopexy. Specific literature identifying the risk factors for lower urinary tract injury during pelvic reconstructive surgery is lacking; therefore; we aim to identify the patient characteristics predisposing a patient to lower urinary tract injury during laparoscopic sacrocolpopexy.OBJECTIVEThe primary objective of this study was to identify the patient-specific risk factors for lower urinary tract injury with laparoscopic sacrocolpopexy.STUDY DESIGNThis was an age-matched, case-control study including patients who underwent laparoscopic sacrocolpopexy from July 2014 to December 2017 in a high-volume female pelvic medicine and reconstructive surgery practice. The patients were excluded if they underwent laparoscopic uterosacral ligament suspension, had abnormal urinary tract anatomy, or for incorrect, incomplete, or duplicated data. Risk factors such as race, body mass index, pelvic organ prolapse quantification stage, previous abdominal and/or vaginal surgeries, and concurrent procedures (lysis of adhesions, adnexal surgery, midurethral sling placement, and anterior or posterior colporrhaphy) were analyzed. Groups were compared using the Student t-test for independent samples and chi-square tests. Conditional logistic regression was used to estimate the crude and adjusted odds ratios.RESULTSA total of 930 patients were identified during electronic medical record chart review using the current procedural terminology code 57425 (laparoscopic colpopexy). A total of 167 patients met the exclusion criteria, resulting in a total of 763 patients for primary analysis. The prevalence of lower urinary tract injury was 2.4% (17 bladder injuries and 1 ureteral injury out of 763 laparoscopic sacrocolpopexy procedures). These 18 cases were age-matched to 72 controls. The mean age and body mass index of all patients was 64.8 years (±9.32) and 26.5 kg/m2 (±3.99), respectively. Most of the patients were Caucasian, had previously undergone abdominal and/or vaginal surgery, had pelvic organ prolapse stage 3 or greater, and underwent concurrent surgeries, including adnexal surgery and midurethral sling placement at the time of laparoscopic sacrocolpopexy. A history of previous hysterectomy (odds ratio, 19.94; 95% confidence interval, 2.48–160.38; P=.005) and lysis of adhesions at the time of laparoscopic sacrocolpopexy (odds ratio, 4.94; 95% confidence interval, 1.05–23.19; P=.043) were associated with an increased odds of lower urinary tract injury in unadjusted models. In a multivariable logistic regression model controlling for the previously listed variables, a history of previous hysterectomy remained significantly associated with lower urinary tract injury (adjusted odds ratio, 162.41; 95% confidence interval, 3.21–8227; P=.011). Race, body mass index, pelvic organ prolapse quantification system stage, previous abdominal and/or vaginal surgery, and concurrent procedures were not associated with an increased risk of lower urinary tract injury.CONCLUSIONAlthough lower urinary tract injury with laparoscopic sacrocolpopexy only occurred in 2.4% of patients, previous hysterectomy increased this risk substantially. As sacrocolpopexy is the common treatment for prolapse after hysterectomy or recurrent prolapse, this increased risk of lower urinary tract injuries can guide surgical counseling on the basis of patient-specific risk factors and aid in setting appropriate postoperative patient expectations.

The Role of Laparoscopic Surgery in the Treatment of Advanced Uterine Prolapse: A Systematic Review of the Literature.

The aim of this review is to investigate and compare all laparoscopic techniques that can be used in the surgical repair of advanced uterine prolapse. A systematic search of the PubMed, Scopus, Cochrane CENTRAL, and Clinicaltrials.gov databases was performed for articles published up to December 2020, reporting data on the treatment of severe uterine prolapse using laparoscopic procedures. Only studies in the English language, with a patient sample of ≥20 and a follow-up time of ≥12 months were included. The final synthesis of this review consisted of six studies. The main laparoscopic procedures reported were vaginally assisted laparoscopic sacrocolpopexy, vaginally assisted laparoscopic uterine sacropexy, laparoscopic sacrocolpopexy with laparoscopic supracervical hysterectomy, laparoscopic inguinal ligament suspension with uterine preservation, and laparoscopic uterosacral ligament suspension combined with trachelectomy. All procedures involved mesh placement, except for laparoscopic uterosacral ligament suspension. All procedures reported anatomical cure rates > 90%. Vaginally assisted laparoscopic sacrocolpopexy had the largest amount of intraoperative blood loss whilst vaginally assisted laparoscopic uterine sacropexy was associated with bladder injuries intraoperatively. All vaginally assisted procedures reported cases of mesh extrusion postoperatively. Laparoscopic inguinal ligament suspension was the operation with the longest mean operative and hospitalization time. Conversions were not reported. The present study shows that minimally invasive surgery can be used efficiently as an alternative to open surgery in the treatment of severe uterine prolapse.

71 Laparoscopic sacrocolpopexy and laparoscopic uterosacral ligament suspension: Operative outcomes and recurrence rate

Laparoscopic sacrocolpopexy (LSC) has been shown to have a 5-year re-operation rate of 3.5% for apical pelvic organ prolapse (Sarlos et al). Some patients desire mesh-free repair due to concerns about mesh complications. Laparoscopic uterosacral ligament suspension (L-USLS) is one approach to repair apical pelvic organ prolapse and does not involve mesh. We present our institutional outcomes and recurrence rate for LSC and L-USLS. Our primary objective is to the operative outcomes between LSC and USLS (estimated blood loss, operative time, and length of hospitalization). Our secondary objective is the rate of perioperative complications and rate of symptomatic recurrent prolapse. This was a retrospective chart review of 255 women who underwent LSC or L-USLS at one institution between 3/2017 and 8/2019 for apical pelvic organ prolapse. Patient demographics, surgical data, complications, and post-operative follow up data were abstracted. Student’s t-test and Chi-squared test were used as appropriate. In total, 142 women underwent LSC and 113 women underwent L-USLS. Women in the LSC group were older (65 vs 59 years old, P< 0.01) and were more likely to have a prior hysterectomy (75% vs 11%, P< 0.01) or prior pelvic organ prolapse repair (30% vs 8, P< 0.01). Baseline POP-Q (Pelvic organ prolapse quantification) Stage were similar between groups. Women in the L-USLS group were more likely to undergo hysterectomy (88% vs 25%, P< 0.01) and posterior repair (45% vs 18%, P< 0.01). Estimated blood loss (EBL) was lower in the LSC group (56 mL vs 120 mL, P< 0.01), and operative time was longer in the LSC group (158 min vs 142 min, P< 0.01). Length of hospitalization was similar between the groups; patients were discharged on POD 0 or 1 in 92% of the L-USLS group and 97% of LSC group. The rate of perioperative complications between L-USLS and LSC was similar (7% vs 6%, P=0.81). In addition, urinary retention requiring discharge with a catheter was similar between the groups (24% vs 26%, P=0.69). Mesh erosion occurred in one patient in the LSC group. Pelvic pain was reported by 1 patient in the L-USLS group and 6 patients in the LSC group. One patient in the LSC group required takedown of sacrocolpopexy mesh due to persistent pain. The mean follow up was 23 weeks (range 0-33 months). Symptomatic recurrent prolapse of any compartment, which was defined as patient report of bulge symptoms or re-operation, occurred in 7 patients in the L-USLS group and 11 patients in the LSC group (6% vs 7%, P=0.63). Symptomatic apical pelvic organ prolapse occurred in 5 patients in the L-USLS group and 3 patients in the LSC group. In our cohort, LSC was associated with decreased blood loss and increased operative time compared to L-USLS. There was no difference in length of stay, perioperative complications, or recurrence rate between the groups

30 Laparoscopic uterosacral ligament suspension: A modification of the box stitch technique

30 Laparoscopic uterosacral ligament suspension: A modification of the box stitch technique

Clinical outcomes and uroflowmetry assessment in patients with apical prolapse after laparoscopic uterosacral ligament suspension

ObjectiveThe aim was to evaluate the voiding function and voiding dysfunction 3 months after laparoscopic uterosacral ligament suspension (LUSLS). We identified risk factors for postoperative voiding dysfunction. Study designThis retrospective study included 57 women with apical prolapse who underwent LUSLS with stage II or greater apical prolapse and without advanced anterior vaginal prolapse (stage III or IV). Data were collected from electronic medical records. Voiding function was assessed by uroflowmetry, PVR examination, and self-report questionnaires (the Pelvic Floor Distress Inventory-20 and the Urinary Impact Questionnaire) at baseline and 3 months after surgery. Voiding dysfunction was defined as an average flow rate (Qave)＜10 ml/s, a maximum flow rate (Qmax)＜15 ml/s, or a postvoid residual volume (PVR)＞50 ml. Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression. ResultsThirty-five percent of women suffered from voiding dysfunction preoperatively. Uroflowmetry parameters and PVR, objective symptoms including voiding difficulties, incomplete empty, frequency and urinary incontinence didn’t show significant improvement postoperatively (all p＞0.05). Low Qave was identified as an independent risk factor of post voiding dysfunction (odds ratio, 0.558; 95 % CI, 0.324−0.963). ConclusionsApproximately one-third of women suffering from apical prolapse without advanced anterior vaginal wall had evidence of voiding dysfunction preoperatively. LUSLS has no obvious effect on uroflowmetry parameters and clinical symptoms.

Laparoscopic uterosacral ligament suspension versus vaginal colposuspension using the Uphold Lite™ mesh system: clinical outcome and patient satisfaction.

The objective was to compare clinical and anatomical outcomes between laparoscopic uterosacral ligament suspension (LUSLS) and vaginal colposuspension using the Uphold Lite™ mesh system for the treatment of apical prolapse. We performed a comparative, retrospective cohort study. All women who underwent either vaginal colposuspension with the Uphold Lite™ System or LUSLS for treatment of apical prolapse between 2010 and 2019 were included. The groups were compared with regard to demographic, pre-operative, intra-operative, and post-operative data. Outcome measures included clinical and anatomical cure, as well as a composite outcome. The PGI-I questionnaire was used to determine patient satisfaction. One-hundred and nineteen women met the inclusion criteria, including 70 women who underwent LUSLS and 49 women who underwent vaginal colposuspension with the Uphold Lite™ mesh system. At a mean follow-up of 31.7 (SD = 18.1) months, the clinical cure rate was high for both groups, reaching 98.6% in the LUSLS group compared with 89.8% in the Uphold group (NS). Anatomical cure rate was 83.6% in the LUSLS group compared with 69.7% for the Uphold group (NS). With regard to the composite outcome, no difference was found, although a trend towards a higher success rate was noted in the LUSLS group (83.6% vs 66.7%, p = 0.055). Patient satisfaction measured using the PGI-I questionnaire was high, at 98.6% in the LUSLS group and 87.8% in the Uphold group (NS). Laparoscopic uterosacral ligament suspension and vaginal colposuspension using the Uphold Lite™ mesh system both have high clinical cure rates.

Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

Background: Many women diagnosed with a gynecologic malignancy may have coinciding urogynecologic complaints, such as pelvic organ prolapse (POP) and/or urinary incontinence, with approximately 35% reporting moderate to severe symptoms. Recent National Surgical Quality Improvement Program (NSQIP) database inquiries of gynecologic cancer cases found only 2.3-2.4% of women undergoing interventional surgery for gynecologic malignancy also had a procedure for pelvic organ prolapse urinary incontinence (POPUI), and those combination cases did not show significant increase in postoperative risks. The purpose of our study is to review our cases of gynecologic cancer that underwent concomitant urogynecologic procedures and compare their perioperative outcomes to gynecologic cancer cases without concomitant urogynecologic procedures. Methods: A retrospective cohort study conducted at a teaching hospital included 29 gynecologic oncology patients who underwent robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Controls underwent standard staging procedure and were compared to women with concomitant pelvic floor dysfunction that underwent additional laparoscopic uterosacral ligament suspension for apical suspension and a sling for stress urinary incontinence (SUI). The primary outcome was operative time, defined as documented total operative time and robot console time. Secondary outcomes include delta hemoglobin, hospital length of stay, readmission rate, total pain medication, urinary retention and discharge with foley. Results: The combined case group had longer total procedure time duration (301 minutes versus 210 minutes, p-value &lt; 0.0001), with comparable mean console time (178 minutes versus 160 minutes; p = 0.1456). Blood loss estimated by mean percent difference of Hgb showed moderate conditional dependence on surgical case (22.2% cases versus 14.9% controls, p-value 0.04). Combined cases resulted in 76.9% of subjects discharged with a foley catheter compared to none in controls (p-value &lt; 0.0001). Otherwise, there was no difference in the other perioperative outcomes between the two groups. Conclusion: With appropriate counseling and clinical judgement, combined urogynecologic and gynecologic oncologic surgeries can be performed to improve a patient’s quality of life (QOL) with minimal increase in perioperative morbidity.

67: Rate of ureteral compromise and recurrent prolapse following laparoscopic uterosacral ligament suspension: A retrospective study

67: Rate of ureteral compromise and recurrent prolapse following laparoscopic uterosacral ligament suspension: A retrospective study

Laparoscopic uterosacral ligament suspension vs laparoscopic sacral colpopexy in patients with pelvic organ prolapse: intermediate term follow-up of a retrospective study

Laparoscopic uterosacral ligament suspension vs laparoscopic sacral colpopexy in patients with pelvic organ prolapse: intermediate term follow-up of a retrospective study

2126 Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

Study Objective To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. Design A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Setting Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. Patients or Participants 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Interventions Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Measurements and Main Results Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Conclusion Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures. To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures.

Prophylactic Laparoscopic Uterosacral Ligament Suspension

Video Objective To demonstrate the benefit and feasibility of prophylactic uterosacral ligament suspension at time of hysterectomy, in hopes of reducing post-hysterectomy vaginal vault prolapse. Setting Hospital. Interventions Hysterectomy and Uterosacral ligament Suspension. Conclusion Laparoscopic uterosacral ligament suspension may be performed during laparoscopic hysterectomy to reduce the risk of post-hysterectomy vaginal vault prolapse. To demonstrate the benefit and feasibility of prophylactic uterosacral ligament suspension at time of hysterectomy, in hopes of reducing post-hysterectomy vaginal vault prolapse. Hospital. Hysterectomy and Uterosacral ligament Suspension. Laparoscopic uterosacral ligament suspension may be performed during laparoscopic hysterectomy to reduce the risk of post-hysterectomy vaginal vault prolapse.

Laparoscopic Uterosacral Ligament Suspension with the Use of Barbed Suture

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.

Evaluation of Opioid Prescriptions After Urogynecologic Surgery Within a Large Health Care Organization: How Much Are We Prescribing?

Data regarding postoperative opioid prescriptions for patients undergoing urogynecologic surgery are sparse. Our objective was to quantify surgeon prescribing patterns for patients undergoing surgery for pelvic organ prolapse or stress urinary incontinence. Patients who underwent surgery for pelvic organ prolapse or SUI within a large health care maintenance organization were identified by procedural codes within the electronic medical record. Medical records were reviewed for demographic and clinical data. Our primary objective was to describe initial postoperative morphine milligram equivalent (MME) dosages for patients undergoing various urogynecologic surgeries. Secondary objectives were to evaluate rates of postoperative non-opioid analgesic prescriptions, presence of additional postoperative opioid prescriptions within 90 days of surgery, and to characterize prescribing patterns of surgeons from different specialties. We evaluated 855 patients undergoing 7 urogynecologic surgeries. There was wide variation in the quantity of MME prescribed to patients undergoing different urogynecologic surgeries, and the mean MME ranged from 137.6 mg after a colpocleisis to 214.1 mg after a laparoscopic uterosacral ligament suspension. Less than two thirds of patients received a postoperative nonsteroidal anti-inflammatory drug (NSAID) prescription, and rates of NSAID prescriptions varied widely between surgeons from different specialties. Thirty-nine (4.6%) patients received an additional postoperative opioid prescription specifically for the indication of persistent postoperative pain. There is wide variation in the range of MME prescribed postoperatively to patients undergoing common urogynecologic surgeries. Less than two thirds of patients received a postoperative NSAID prescription, which was found to be independently associated with a higher postoperative opioid prescription dose.

Laparoscopic Uterosacral Ligament Hysteropexy vs Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction

To compare anatomic and clinical cure rates as well as patient satisfaction between uterine-preserving laparoscopic uterosacral ligament suspension and total vaginal hysterectomy with uterosacral ligament suspension in women with apical and anterior prolapse. Single-center clinical comparative retrospective cohort study. A female pelvic medicine and reconstructive surgery service at a tertiary teaching hospital. Women with pelvic organ prolapse who underwent surgical treatment for their condition between July 2010 and December 2015. All women underwent laparoscopic uterosacral ligament suspension or total vaginal hysterectomy with uterosacral ligament suspension for apical and anterior prolapse. Concomitant procedures included anterior and posterior repair, as well as a midurethral sling when indicated. Preoperative and postoperative Pelvic Organ Prolapse Quantification (POP-Q) measurements were obtained. The primary outcome was clinical cure rate. Secondary outcomes included anatomic cure rate and outcomes of site-specific POP-Q points Ba, C, and Bp for the whole cohort. Patient satisfaction was measured using the Patient Global Impression of Improvement questionnaire. During the study period, 106 women underwent transvaginal hysterectomy with uterosacral ligament suspension, and 53 women had laparoscopic uterosacral ligament suspension. At a mean follow-up of 14.7 ± 13.23 months for the vaginal group and 17.5 ± 15.84 months for the laparoscopic group (p = .29), there were significant improvements of POP-Q points Ba, C, and Bp (p < .0001 for all comparisons in both groups). The clinical cure rate was 96% in the vaginal group and 98% in the laparoscopic group (p = .50). The anatomic cure rate was 85.4% in the vaginal group and 93.75% in the laparoscopic group (p = .11) Patient satisfaction was high in both groups. In appropriately selected patients, laparoscopic uterosacral ligament suspension is a valid uterus-preserving option for women with anterior and apical prolapse, associated with high anatomic and clinical cure rates and patient satisfaction.