Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches.
OBJECTIVE
To compare the risk of ureteral compromise and of recurrent vault prolapse following vaginal vs. laparoscopic uterosacral vault suspension at the time of vaginal hysterectomy.


METHODS
In this retrospective, cohort study, uterosacral ligament suspension was performed using either a vaginal or laparoscopic approach. The primary outcome was intraoperative ureteral compromise; secondary outcomes were postoperative anatomic result and recurrent prolapse. The Canadian Task Force Classification was II-2.


RESULTS
One hundred eighteen patients were included: 96 patients in the vaginal group and 22 patients in the laparoscopic group. Ureteral compromise was identified intraoperatively in 4 (4.2%) cases in the vaginal group; no ureteral compromise was observed in the laparoscopic group (p = 0.33). Failure at the apex, defined as stage > or = II for point C, was seen in 6.3% of patients in the vaginal group as compared with 0% in the laparoscopic group; this difference did not achieve statistical significance. Similarly, trends toward lower recurrent symptomatic vault prolapse (10% vs. 0%), any symptomatic prolapse recurrence (12.5% vs. 4.6%), and higher postoperative Pelvic Organ Prolapse Quantification point C were observed in the laparoscopic group (p > 0.05 for all).


CONCLUSIONS
Laparoscopic uterosacral vault suspension following vaginal hysterectomy is a safe alternative to the vaginal approach.
Rardin
Charles R
CR
Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, 695 Eddy Street, Suite 12, Providence, RI 02903, USA. crardin@wihri.org
Erekson
Elisabeth A
EA
Sung
Vivian W
VW
Ward
Renee M
RM
Myers
Deborah L
DL
D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012447:Sacrum; D014515:Ureteral Diseases / Q000453:epidemiology / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus; D014621:Vagina / Q000601:surgery*