Abstract
Objectives: Colposuspension after a hysterectomy is essential for patients with pelvic organ prolapse (POP). Shull's method is one of the most popular transvaginal colposuspension methods. It uses the uterosacral ligaments and has been reported to be a superior procedure. However, sometimes it is difficult to identify the ligaments in POP patients; thus, increasing the risk of recurrence. In addition, the uterosacral ligaments are very close to the ureters; thus, there is a risk of ureteral injury during the procedure. We report a novel laparoscopic colposuspension procedure, which reduces the risk of recurrences and ureteral injury.
Material and methods: From July 2013 to April 2014, POP patients with Delancey level 1 injury who underwent a laparoscopic Shull's colposuspension were enrolled in this study. The operative procedure was as follows. The uterosacral ligaments were detected before hysterectomy and separated from the ureters. After the hysterectomy, three sutures were placed between the vaginal cuff and the uterosacral ligaments bilaterally. The pouch of Douglas was closed with a continuous retroperitoneal suture.
Results: The study group comprised 59 patients. The average patient age was 68 years (range: 49-80 years), the average surgery time was 146 minutes (75-252 minutes), the average blood loss was 83 ml (range: 10-500 ml). The only complication was one bladder injury (2%). No recurrences had occurred at postoperative month 3.
Conclusions: A laparoscopic uterosarcal ligament colposuspension was found to reduce the risk of the recurrence, ureteral injuries, and surgical site infections; in addition, it avoids the use of mesh usage. This colposuspension method appears to be one of the most useful methods for POP patients.
