Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy

  • 580 Accesses

  • 4 Citations


Introduction and Hypothesis

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.


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.


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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    Committee on Gynecologic Practice (2011) Committee opinion no. 513: vaginal placement of synthetic mesh for pelvic organ prolapse. Obstet Gynecol 118(6):1459–1464. doi:10.1097/AOG.0b013e31823ed1d9.

  2. 2.

    Shull BL, Bachofen C, Coates KW, Kuehl TJ (2000) A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 183(6):1365–1373. doi:10.1067/mob.2000.110910; discussion 1373–1364.

  3. 3.

    Burks FN, Santucci RA (2014) Management of iatrogenic ureteral injury. Ther Adv Urol 6(3):115–24. doi:10.1177/1756287214526767.

  4. 4.

    Vakili B, Chesson RR, Kyle BL, Shobeiri SA, Echols KT, Gist R et al (2005) The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy. Am J Obstet Gynecol 192(5):1599–1604. doi:10.1016/j.ajog.2004.11.016.

  5. 5.

    Kato T, Murakami G, Yabuki Y (2003) A new perspective on nerve-sparing radical hysterectomy: nerve topography and over-preservation of the cardinal ligament. Jpn J Clin Oncol 33(11):589–591

  6. 6.

    Yabuki Y, Sasaki H, Hatakeyama N, Murakami G (2005) Discrepancies between classic anatomy and modern gynecologic surgery on pelvic connective tissue structure: harmonization of those concepts by collaborative cadaver dissection. Am J Obstet Gynecol 193(1):7–15. doi:10.1016/j.ajog.2005.02.108.

Download references

Author information

Correspondence to Kazuaki Yoshimura.

Ethics declarations

Conflicts of interest



Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MP4 81800 kb)


(MP4 81800 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nishimura, K., Yoshimura, K., Hoshino, K. et al. Laparoscopic fixation of the vaginal cuff to the uterosacral ligaments at the time of hysterectomy. Int Urogynecol J 28, 321–323 (2017).

Download citation


  • Uterosacral ligament colpopexy
  • Pelvic organ prolapse
  • Laparoscopy
  • Native tissue repair