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uterosacral ligament suspension in vaginal hysterectomy

Stefano Restaino, Carlo Ronsini, Angelo Finelli, Alessandro Santarelli, Giovanni Scambia, Francesco Fanfani
Study Objective To prove the feasibility of Shull technique by a laparoscopy approach in patient affected by pelvic organ prolapse (POP) with apical loss of support. Design A step-by-step demonstration of the technique in a surgical video, including the fundamental steps for a laparoscopic uterosacral ligament suspension (USLS) (Canadian Task Force Classification III). Setting According to the National Health and Nutrition Examination Survey, approximately 3% of women in the United States report symptoms linked to POP...
December 28, 2017: Journal of Minimally Invasive Gynecology
Cæcilie Krogsgaard Tolstrup, Karen Ruben Husby, Gunnar Lose, Tine Iskov Kopp, Petra Hall Viborg, Ulrik Schiøler Kesmodel, Niels Klarskov
INTRODUCTION AND HYPOTHESIS: This study compares vaginal hysterectomy with uterosacral ligament suspension (VH) with the Manchester-Fothergill procedure (MP) for treating pelvic organ prolapse (POP) in the apical compartment. METHODS: Our matched historical cohort study is based on data from four Danish databases and the corresponding electronic medical records. Patients with POP surgically treated with VH (n = 295) or the MP (n = 295) in between 2010 and 2014 were matched for age and preoperative POP stage in the apical compartment...
December 29, 2017: International Urogynecology Journal
Charles W Nager, Cara L Grimes, Tracy L Nolen, Clifford Y Wai, Linda Brubaker, Peter C Jeppson, Tracey S Wilson, Anthony G Visco, Matthew D Barber, Gary Sutkin, Peggy Norton, Charles R Rardin, Lily Arya, Dennis Wallace, Susan F Meikle
OBJECTIVE: The aim of the study was to compare anterior and overall prolapse prevalence at 1 year in surgical participants with or without concomitant anterior repair (AR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS). METHODS: This is a secondary analysis of two surgical trials; concomitant AR was performed at surgeon's discretion. Anterior anatomic success was defined as pelvic organ prolapse quantification of prolapse point Ba ≤0 and overall success was defined as pelvic organ prolapse quantification points Ba, Bp, and C ≤0 at 12 months...
December 11, 2017: Female Pelvic Medicine & Reconstructive Surgery
Seethalakshmi Krishnan
Background: To assess the quality of life in geriatric patients after reconstructive and obliterative vaginal surgery for advanced pelvic organ prolapse (POP). Methods: Prospective observational study was conducted between January 2009 and December 2014 at the department of Urogynaecology, Government Kasturbha Gandhi Hospital. A total of 424 women (between the age group of 60 and 94 years) with advanced pelvic organ prolapse underwent vaginal hysterectomy along with vaginal apical suspension procedures which were McCalls culdoplasty (35...
December 2017: Journal of Obstetrics and Gynaecology of India
Stefano Manodoro, Matteo Frigerio, Rodolfo Milani, Federico Spelzini
INTRODUCTION AND HYPOTHESIS: Uterosacral ligament (USL) suspension is an effective and versatile surgical technique for repairing pelvic organ prolapse. However, ureteral injury is a feared complication that may act as a significant deterrent to the use of USL suspension. The aim of the video is to provide key steps to minimize the risk of ureteral injury while achieving successful transvaginal USL suspension. METHODS: The featured video provides a series of surgical tips and tricks that can be applied to protect the ureters while achieving USL suspension whether the procedure contemplated is vaginal hysterectomy, vaginal vault repair after hysterectomy, or hysteropexy...
October 16, 2017: International Urogynecology Journal
Megan S Bradley, Jennifer A Bickhaus, Cindy L Amundsen, Laura K Newcomb, Tracy Truong, Alison C Weidner, Nazema Y Siddiqui
OBJECTIVE: The aim of this study was to compare anatomic results after vaginal uterosacral ligament suspension with absorbable versus permanent suture. METHODS: We performed a retrospective cohort study of women who underwent vaginal uterosacral ligament suspension, from 2006 to 2015. We compared 2 groups: (1) absorbable suspension suture and (2) permanent suspension suture (even if accompanied by absorbable suture). Our primary outcome was composite anatomic failure defined as (1) recurrent prolapse in any compartment past the hymen or (2) retreatment for prolapse...
June 27, 2017: Female Pelvic Medicine & Reconstructive Surgery
Rodolfo Milani, Matteo Frigerio, Alice Cola, Carlo Beretta, Federico Spelzini, Stefano Manodoro
BACKGROUND: Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse. OBJECTIVES: There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment...
February 23, 2017: Female Pelvic Medicine & Reconstructive Surgery
Tarek Khalife, Rabbie K Hanna
OBJECTIVES: Hysterectomy is among the most common gynecologic procedures performed for women, second only to cesarean sections, and the proportion of it performed laparoscopically continues to increase. Addressing apical support at the time of the hysterectomy is crucial to minimizing the risk of posthysterectomy prolapse. Barriers to addressing apical support include the lack of experience in laparoscopic suturing and knot tying that require advanced skills and dexterity. The K-technique is a novel modification of the uterosacral ligament suspension procedure using the knot-less barbed suture technology, rendering suturing easier and quicker to perform...
March 2017: Female Pelvic Medicine & Reconstructive Surgery
Lauren B Westermann, Catrina C Crisp, Donna Mazloomdoost, Steven D Kleeman, Rachel N Pauls
BACKGROUND: In this study of patients undergoing vaginal hysterectomy with either robotic or vaginal prolapse repair, there was no difference in quality of life in the weeks following surgery; however, less narcotics were used, less pain was documented by nurses and Surgical Pain Scale (SPS), and better performance on voiding trials was noted in those undergoing robotic sacrocolpopexy. OBJECTIVES: Minimally invasive surgery for pelvic organ prolapse is the preferred surgical route for optimal recovery...
March 2017: Female Pelvic Medicine & Reconstructive Surgery
Kristina Butler, John Yi, Megan Wasson, Jennifer Klauschie, Debra Ryan, Joseph Hentz, Jeffrey Cornella, Paul Magtibay, Roseanne Kho
BACKGROUND: After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief, and their use may exacerbate the incidence of sedation, nausea, and vomiting, which ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia after surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium rectal suppositories may be used to relieve pain and minimize side effects; however, their efficacy has not been confirmed...
May 2017: American Journal of Obstetrics and Gynecology
Pamela S Fairchild, Neil S Kamdar, Emily R Rosen, Carolyn W Swenson, Dee E Fenner, John O DeLancey, Daniel M Morgan
INTRODUCTION AND HYPOTHESIS: The performance of a colpopexy at the time of hysterectomy for pelvic organ prolapse is a potential indicator of surgical quality. However, vaginal colpopexy has not been directly compared with the classic technique of ligament shortening and reattachment. We sought to test the null hypothesis that there is no difference in prolapse recurrence between the techniques. METHODS: We performed a retrospective chart review of 330 vaginal hysterectomies performed for prolapse, comparing symptomatic and/or anatomic recurrence rates between patients having a vaginal colpopexy (uterosacral ligament suspension or sacrospinous ligament suspension) and those having ligament shortening and reattachment...
June 2017: International Urogynecology Journal
Lauren N Siff, Karl Jallad, Javier Pizarro-Berdichevsky, Mark D Walters
AIM OF THE VIDEO: The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives. METHODS: This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH...
January 2017: International Urogynecology Journal
Vaneesha Vallabh-Patel, Cristina Saiz, Charbel Salamon
OBJECTIVES: This study was designed to assess the short-term outcomes in patients undergoing robotic or transvaginal high uterosacral ligament suspension for symptomatic apical prolapse at the time of hysterectomy. METHODS: This retrospective study used hospital and office electronic medical records to identify patients with symptomatic stage 2 to 4 prolapse, who had undergone either a robotic or transvaginal high uterosacral ligament suspension from July 2010 to January 2014...
July 25, 2016: Female Pelvic Medicine & Reconstructive Surgery
Carlo Rappa, Gabriele Saccone
BACKGROUND: Obesity is one of the most important risk factors for the development and progression of the pelvic organ prolapse. However, data regarding whether obesity is a risk factor for recurrence after pelvic organ prolapse surgery are controversial. OBJECTIVE: The aim of this study was to estimate the risk of recurrent prolapse in any vaginal compartment after total vaginal hysterectomy with concurrent uterosacral ligament vaginal vault suspension among normal-weight women compared with either overweight or obese women...
November 2016: American Journal of Obstetrics and Gynecology
Ewa Milnerowicz-Nabzdyk, Mariusz Zimmer
INTRODUCTION: Pelvic organ prolapse (POP) is treated with a great variety of procedures and none is fully satisfactory. The aim of the study was to introduce and evaluate the effectives of laparoscopic trans teres vault suspension (LTTVS) technique as a new method for POP treatment. MATERIAL AND METHODS: In the years 2013-2014, eight symptomatic women with grades II-IV POP underwent LTTVS procedure. The mean age of patients was 65.25 years (range from 52 to 76 years)...
March 2016: Przeglad Menopauzalny, Menopause Review
Federico Spelzini, Matteo Frigerio, Stefano Manodoro, Maria Lieta Interdonato, Maria Cristina Cesana, Debora Verri, Caterina Fumagalli, Martina Sicuri, Elena Nicoli, Serena Polizzi, Rodolfo Milani
INTRODUCTION AND HYPOTHESIS: Uterosacral ligament suspension at the time of primary prolapse repair represents a well-established surgical option. Our aim was to compare the effectiveness, complications rate, and functional results of modified McCall culdoplasty and Shull suspension. METHODS: Patients who underwent vaginal hysterectomy and cuff suspension for pelvic organ prolapse were retrospectively analyzed. McCall culdoplasty (group A) or Shull suspension (group B) were performed according to surgeon choice based on age and sexual activity...
January 2017: International Urogynecology Journal
Lee A Richter, Jenine Boileau, Megan Janni, Eshetu Tefera, Cheryl B Iglesia
OBJECTIVE: To determine the rate of ureteral kinking during uterosacral ligament suspension (USLS) procedures at a tertiary referral center and to describe the effect of surgical training level on this occurrence. The secondary aim is to determine the mean additional anesthesia time associated with management of this complication. STUDY DESIGN: This retrospective cohort study included all USLS procedures at our tertiary referral center from June 2011 to December 2013...
January 2016: Journal of Reproductive Medicine
Lauren N Siff, Matthew D Barber
This report reviews the success rates and complications of native tissue (nonmesh) vaginal reconstruction of pelvic organ prolapse by compartment. For apical prolapse, both uterosacral ligament suspensions and sacrospinous ligament fixations are effective and provided similar outcomes in anatomy and function with few adverse events. In the anterior compartment, traditional colporrhaphy technique is no different than ultralateral suturing. In the posterior compartment, transvaginal rectocele repair is superior to transanal repair...
March 2016: Obstetrics and Gynecology Clinics of North America
Renée J Detollenaere, Ilse A M Kreuwel, Jeroen R Dijkstra, Kirsten B Kluivers, Hugo W F van Eijndhoven
INTRODUCTION: Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. AIMS: The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse...
February 2016: Journal of Sexual Medicine
Lindsay C Turner, Erin S Lavelle, Jonathan P Shepherd
INTRODUCTION AND HYPOTHESIS: Our objective was to compare complications and prolapse recurrence between laparoscopic (L-USLS) and vaginal (V-USLS) uterosacral ligament suspensions. METHODS: This is a retrospective study of USLS procedures performed at a large academic center from 2011 to 2014. Patient demographics, surgical data, complications, and prolapse recurrence of L-USLS and V-USLS were compared. Logistic regression identified predictors of operative time, complications, and prolapse recurrence...
May 2016: International Urogynecology Journal
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