title: Transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair.
abstract: OBJECTIVE
  Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with native tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.
  
  
  METHODS
  A 57-year-old woman with symptomatic stage 2 vaginal vault prolapse underwent transvaginal USL suspension according to the described technique.
  
  
  RESULTS
  Surgical procedure was successfully achieved without complications. Final examination revealed excellent apical support and preservation of vaginal length. However, ureteral damage represents the major pitfall of USL suspension. This step-by-step video tutorial may represent an important tool to improve surgical know how and minimize the risk of ureteral injury.
  
  
  CONCLUSIONS
  Transvaginal USL suspension provides an effective technique for apical support without the use of prosthetic materials. Intimate understanding of pelvic anatomy, direct visualization of ureter, and proper suture positioning are the key points to minimize the risk of complications.
authors.affiliation: ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.affiliation: ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: AUSL Romagna, Infermi Hospital, University of Milano-Bicocca, Rimini, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Spelzini
authors.affiliation: ASST Monza, Ospedale San Gerardo, U.O. Ginecologia, Via Pergolesi, 33, 20900, Monza, MB, Italy. stefano.manodoro@gmail.com.
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0002-1837-0806
authors.initials: S
authors.lastname: Manodoro
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012447:Sacrum / Q000601:surgery; D013536:Suture Techniques; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery
keywords: Native-tissue repair; Pelvic organ prolapse; Uterosacral ligament suspension; Vaginal vault prolapse; Video tutorial