Ureteral Compromise in Laparoscopic Versus Vaginal Uterosacral Ligament Suspension: A Retrospective Cohort.
OBJECTIVE
The aim of this study was to evaluate if ureteral compromise is significantly different between laparoscopic and vaginal uterosacral ligament suspension (USLS).


METHODS
This is a retrospective cohort study comparing all women who underwent laparoscopic and vaginal USLSs at 2 institutions (part of a single training program with procedures performed by 11 fellowship-trained Female Pelvic Medicine and Reconstructive Surgery gynecologic surgeons) between January 2008 and June 2013.


RESULTS
A total of 208 patients in the study underwent a USLS, 148 in the laparoscopic group and 60 in the vaginal group. At baseline, there were statistically significant differences between the groups in mean age (50.4 vs 55.3 years, P = 0.008), parity (2.44 vs 2.77, P = 0.040), and prior hysterectomy (3.4% vs 11.7% in the laparoscopic and vaginal groups, respectively; P = 0.042).There were no ureteral compromises in the laparoscopic group and 6 in the vaginal group (0.0% vs 10.0%, respectively; P < 0.001). In an analysis evaluating only those ureteral compromises requiring stent placement, the higher rate of ureteral compromise in the vaginal group persisted despite exclusion of those cases requiring only suture removal and replacement (0.0% vs 5.0% in the laparoscopic and vaginal groups, respectively; P = 0.023).There was a lower median blood loss in the laparoscopic group (137.5 vs 200.0 mL, respectively; P = 0.002) as well as a lower rate of readmission (0.7% vs 6.7%, respectively; P = 0.025). There were no other significant differences in postoperative complications between the 2 groups.


CONCLUSIONS
We found a lower rate of ureteral compromise in the laparoscopic approach to USLS compared with the traditional vaginal approach.
From the *Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD; †Department of Obstetrics and Gynecology, George Washington University, Washington, DC; and ‡Inova Fairfax Hospital, Annandale, VA.
Heather M
HM
Barbier
Margo Z
MZ
Smith
Chidimma U
CU
Eto
Jeffrey A
JA
Welgoss
Walter
W
Von Pechmann
Nicolette
N
Horbach
Daniel D
DD
Gruber
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries*