A review of laparoscopic uterine suspension procedures for uterine preservation.Curr Opin Obstet Gynecol 2005; 17(5):541-6CO
PURPOSE OF REVIEW
The most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. Uterine suspension procedures can be performed abdominally, vaginally, or laparoscopically. This article focuses on the three different laparoscopic approaches of uterine suspension for uterine preservation: suspension to the round ligaments; suspension to the uterosacral ligaments; and suspension to the anterior ligament of the sacral promontory. This article reviews the published studies in the literature, analyzes the results, discusses the differences, and compares the different laparoscopic techniques.
A review of the literature reveals a paucity of research studies and publications on laparoscopic uterine suspension procedures. All the published studies are small, retrospective case series or case studies. Laparoscopic ventrosuspension using the round ligaments for uterine prolapse has a reported success rate of less than 50%. The ventrosuspension procedure has a very limited role and should not be employed. In comparison, laparoscopic uterine suspension procedures have a reported success rate ranging between 81 and 100%. The newest surgical technique is the laparoscopic sacral colpohysteropexy and there is only one reported case series on this procedure. The reported success rate for the sacral colpohysteropexy is 100%.
The first surgical option for uterine preservation is uterine suspension to the uterosacral ligaments. If the uterosacral ligaments cannot be identified or the uterosacral ligaments are weak and unusable, then laparoscopic sacral colpohysteropexy is a reliable second option. Uterine suspension to the round ligaments has an unacceptably high failure rate and is not an effective, durable alternative.