21: Laparoscopic uterosacral ligament suspension with use of barbed suture


      To demonstrate the technique for performing uterosacral ligament suspension by using barbed suture, which adds to ease of procedure and decreased risk of complications


      In this video, we demonstrate the technique for the laparoscopic uterosacral ligament suspension via the use of barbed suture. The patient is a 49-year-old female who presented to her OB/GYN with complaints of prolapse and urinary discomfort. She originally underwent a supracervical hysterectomy in 2010. The patient began experiencing the symptoms of prolapse roughly 1 year ago. She was referred to urogynecology for evaluation and treatment. To begin the procedure, vital structures are identified, including ureters, uterosacral ligaments, and internal iliac arteries. Trachelectomy is performed and the vaginal cuff is closed using delayed absorbable suture. Each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament, taking care to place each stitch at the level of the ischial spines, thus decreasing the risk of sacral nerve root entrapment. All sutures used for this procedure were barbed sutures. After ensuring hemostasis, ureteral peristalsis is visualized bilaterally. Brisk ureteral efflux was noted bilaterally via cystoscopy at the end of the procedure.


      Uterosacral ligament suspension can be an ideal procedure for the treatment of pelvic organ prolapse. As noted in this video, the procedure can be efficiently conducted laparoscopically and care can be taken to decrease the risk of both ureteral and sacral nerve injuries. The use of barbed suture aids with the ease of procedure and can decrease risk of complications. Additionally, USLS leads to minimal distortion of the vaginal axis compared to other procedures.