Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy.
OBJECTIVE
Transvaginal ipsilateral uterosacral ligament colpopexy for pelvic organ prolapse (POP), which was reported by Shull et al. (Shull's colpopexy) in 2000, is one of the most frequently performed non-mesh pelvic floor reconstructive surgical procedures. Despite its excellent anatomical outcomes, ureteral injury and difficulty in uterosacral ligament detection (especially in patients with severe POP) are typical issues with this procedure.


METHODS
This video demonstrates the procedure in a 58-year-old woman, gravida 2 para 2, with POP-Q stage II uterine prolapse and stage I cystocele. At the beginning of the operation, the bilateral uterosacral ligaments were confirmed and separated from the ureters after entering the retroperitoneal space. The inferior hypogastric nerve and pelvic nerve plexus were also separated from the uterosacral ligament. After total laparoscopic hysterectomy, three ipsilateral delayed absorbable monofilament sutures were placed between the uterosacral ligament and the vaginal cuff. Retroperitonealization was then performed using a continuous suture with closure of the Douglas pouch.


CONCLUSIONS
Laparoscopic Shull's colpopexy for POP is a secure procedure with the advantages of laparoscopy (magnification and sharing the operative field). This may become one of the most useful operations for apical support as native tissue repair.
Department of Obstetrics and Gynecology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan.
Kazuaki
K
Nishimura
Department of Obstetrics and Gynecology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan. yoppy@med.uoeh-u.ac.jp.
Kazuaki
K
Yoshimura
Department of Obstetrics and Gynecology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan.
Kaori
K
Hoshino
Japan, Obstetrics and Gynecology, University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, 808-0024, Japan.
Toru
T
Hachisuga
D052858:Cystocele / Q000601:surgery*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*
Laparoscopy; Native tissue repair; Pelvic organ prolapse; Uterosacral ligament colpopexy