Abstract:

Pelvic organ prolapse (POP) is a common problem requiring surgical correction in up to 19% of women. Abdominal sacrocolpopexy (SCP) is considered the gold standard treatment for apical POP and has been associated with lower rates of recurrent prolapse and dyspareunia compared with vaginal POP repair procedures. Total laparoscopic hysterectomy (TLH) with concurrent laparoscopic uterosacral ligament (USL) vaginal vault suspension provides a safe and effective alternative technique that has efficacy rates similar to abdominal SCP without the use of synthetic mesh. The uterosacral ligaments provide a strong supportive tissue for vaginal vault suspension that mimics the natural support system of the pelvic floor. The most challenging aspect of the TLH with laparoscopic USL suspension is laparoscopic suturing and intra/extracorporeal knot tying. Developing technologies such as robotics, automatic suturing devices, and new barbed suture materials are now providing simpler, alternative surgical techniques that will hopefully shorten operative times and increase adoption of this surgical procedure by gynecologists. With continued progress and refinement of this technique, the TLH with laparoscopic USL suspension may challenge the current standard of care for surgical treatment of POP.

Authors:

Britton Crigler, MD, Resident PGY-4, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine Tampa, Florida, Mark Zakaria, MD, Fellow in Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, USF Center for Advanced Medical Learning and Simulation (CAMLS) University of South Florida Morsani College of Medicine,Tampa, Florida, Stuart Hart, MD, FACOG, FACS, Assistant Professor, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Director, USF Center for the Advancement of Minimally Invasive Pelvic Surgery (CAMPS), Medical Director, Tampa Bay Research and Innovation Center (TBRIC), USF Center for Advanced Medical Learning and Simulation (CAMLS),University of South Florida Morsani College of Medicine,Tampa, Florida

PMID: 23225594

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