title: Technique of extraperitoneal uterosacral ligament suspension for apical suspension.
abstract: Vaginal vault prolapse can occur alone or in combination with anterior or posterior compartment prolapse. Apical prolapse has shown a strong correlation with anterior wall prolapse and a moderate correlation with posterior wall prolapse. The McCall culdoplasty uses the extraperitoneal vaginal approach to support the vault at the time of hysterectomy. Sacrospinous fixation and ileococcygeus suspension with or without mesh have also been used for the treatment of vaginal vault prolapse. The uterosacral ligaments can also be used to re-suspend the vaginal vault using the extraperitoneal or transperitoneal approach. With the extraperitoneal approach, the peritoneal sac, which can be difficult to access at times, especially when there are dense pelvic adhesions, does not need to be opened. The extraperitoneal approach also carries a lower risk of ureteric injury, as the ureters and the bladder can be retracted from the field using a Breisky-Navratil retractor.
  
  
  METHODS
  This video, which documents the surgical treatment of a woman with a complete vaginal eversion and grade 3 pelvic organ prolapse (POP), was recorded in a live workshop during the 2015 Urogynaecology and Reconstructive Pelvic Surgery Conference, held in Chennai, India, in January 2015. It is aimed at educating interested surgeons in the technique of extraperitoneal uterosacral suspension.
  
  
  CONCLUSIONS
  This video demonstrates the extraperitoneal approach to uterosacral ligament suspension for apical support in women with vaginal vault prolapse.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, Victoria, 3084, Australia. owlinli@yahoo.com.
authors.forename: Lin L
authors.initials: LL
authors.lastname: Ow
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, Victoria, 3084, Australia.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Walsh
authors.affiliation: Medway Institute of Urogynaecology, Chennai, India.
authors.forename: Natarajan
authors.initials: N
authors.lastname: Rajamaheswari
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 155 Studley Road, Heidelberg, Victoria, 3084, Australia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Extraperitoneal uterosacral ligament suspension; Ureteric injury; Vault suspension