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Abstract

Objective:

This study evaluated the 1-year outcome of laparoscopic high uterosacral-ligament suspension (HULS) of the apical vault following total laparoscopic hysterectomy (TLH) in women with uterine prolapse stage 2 or higher.

Methods:

Women (N = 11) with pelvic organ prolapse (POP) underwent TLH and laparoscopic HULS between 2018 and 2021. (HULS is shown in a Supplementary video.) POP degree was assessed preoperatively via the Pelvic Organ Prolapse Quantification (POP-Q) tool. Successful surgery was: (1) anatomical cure with POP-Q points Aa, Ba, C, Ap, or Bp, less than stage 2 (< 1 cm above the hymen ([–1]) (2) improvement in subjective satisfaction scores on the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Follow-up time was 12 months with assessment of anatomical outcomes via the POP-Q, and patient satisfaction measured with the PFIQ-7.

Results:

Mean POP-Q point C improved from 0 to −8.6 cm at 1 year post-laparoscopic HULS. There were no major intraoperative or postoperative complications (e.g., ureteric or rectal injuries, or massive blood losses needing transfusions). PFI-Q-7 scores improved (mean preoperative 135 versus mean 1 year postoperative 0; p = 0.003); this was statistically significant.

Conclusions:

Laparoscopic HULS of the apical vault following TLH seems to be a highly successful procedure for treating uterine prolapse, although further evaluation with higher-powered studies are needed. Prerequisites to perform laparoscopic HULS safely include familiarity with anatomy of the ureterosacral ligament and its proximity to vital structures as well as surgical expertise in ureterolysis. (J GYNECOL SURG 39:240)

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Supplementary Material

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A 1-Year Analysis of Outcomes of High Laparoscopic Uterosacral-Ligament Suspension in Women with Uterine Prolapse Stage 2 or Higher: Observational Follow-Up at a Tertiary-Referral Center

Abstract

Objective:

Methods:

Results:

Conclusions:

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References

Supplementary Material