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International Urogynecology Journal

, Volume 30, Issue 4, pp 611–621 | Cite as

Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach

  • Sara HoulihanEmail author
  • Shunaha Kim-Fine
  • Colin Birch
  • Selphee Tang
  • Erin A. Brennand
Original Article

Abstract

Introduction and hypothesis

To compare laparoscopic and vaginal approaches to uterosacral ligament vault suspension (USLS) by perioperative data, short-term complications, rates of successful concomitant adnexal surgery and procedural efficacy.

Methods

Retrospective cohort of USLS procedures performed at the time of hysterectomy at a tertiary care center over a 3-year period. Patient demographics, surgical data, concomitant adnexal procedures and complications were abstracted from a surgical database and compared using parametric or non-parametric tests as appropriate. Validated questionnaires (POPDI-6, UDI-6, PROMIS) were used to collect information on recurrence and long-term complications. Patients were analyzed according to both intention-to-treat analysis based on the intended approach and the completed route of surgery to deal with intraoperative conversions.

Results

Two hundred six patients met the criteria for inclusion; 152 underwent vaginal USLS (V-USLS) and 54 laparoscopic USLS (L-USLS). No statistically significant differences in mean case time, postoperative length of stay or perioperative infection were found. While no ureteric obstructions occurred in the L-USLS group, in the V-USLS group 14 (9%) obstructions occurred (p = 0.023). Postoperative urinary retention was higher with V-USLS (31% vs. 15%, p = 0.024). Rates of successfully completed adnexal surgery differed (56% vs. 98%, p < 0.001) in favor of L-USLS. Patient-reported symptomatic recurrence of prolapse was higher in the V-USLS group (41% vs. 24%, p = 0.046); despite this, re-treatment did not differ between the groups (0% vs. 7%, p = 0.113).

Conclusions

Perioperative case time and complications did not differ between approaches. However, rates of completed adnexal surgery were significantly higher in the laparoscopic group, which could influence surgical decisions concerning approaches to prolapse surgery.

Keywords

Pelvic organ prolapse Uterosacral ligament suspension Vaginal surgery Laparoscopic surgery Sacrospinous ligament suspension Complications 

Abbreviations

SSLF

Sacrospinous ligament fixation

US

Uterosacral

USLS

Uterosacral ligament suspension

V-USLS

Vaginal uterosacral ligament vault suspension

L-USLS

Laparoscopic uterosacral ligament vault suspension

UVS

Uterosacral vault suspension

MMC

Mayo-McCall culdoplasty

VH

Vaginal hysterectomy

OR

Operating room

BMI

Body mass index

ASA

American Society of Anaesthesiology

POP–Q

Pelvic organ prolapse quantification system

EBL

Estimated blood loss

LOS

Length of stay

POPDI-6

6-Question Pelvic Organ Prolapse Distress Inventory

NIH PROMIS SexFS

National Institutes of Health’s Patient-Reported Outcomes Measurement Information System sexual function questionnaire

UDI-6

Urinary Distress Inventory

POP

Pelvic organ prolapse

IQR

Interquartile range

UTI

Urinary tract infection

OBS

Opportunistic bilateral salpingectomy

EOC

Epithelial ovarian cancer

TVL

Total vaginal length

Notes

Funding

This study was funded by the Department of Obstetrics and Gynecology DEAR/Leadership Circle Fund, University of Calgary.

Compliance with ethical standards

Conflicts of interest

Erin Brennand has received grant-in-aid funding for investigator-initiated research from Boston Scientific and Contura International. Colin Birch has accepted paid travel expenses and speaker honoraria from Boston Scientific. Sara Houlihan, Shunaha Kim-Fine and Selphee Tang have no declarations.

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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

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