High uterosacral ligament suspension in radical hysterectomy: a step-by-step procedure to prevent pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Given the younger age of cervical cancer patients and improved postoperative survival, postoperative quality of life should be a reason for concern, particularly given the prevalence of pelvic floor dysfunction. High uterosacral ligament suspension (HUS) has been deemed the more consistently successful surgery for the treatment of mid-pelvic abnormalities. HUS intraoperatively prevents pelvic floor dysfunction effectively.

METHODS

We demonstrate the steps of surgery using surgical video and photographs. The uterosacral ligament is fan shaped and connected to the fascial and extraosseous membranes on the surface of the anterior sacral foramen of the 2nd, 3rd, and 4th sacral vertebrae. Given that the uterosacral ligament was fan-shaped, the fan-shaped suture with three stitches was more compatible with the original anatomy.

RESULTS

Thirty patients with HUS who underwent thorough hysterectomy had no complications, operation time 230.82 ± 43.61 min, and blood loss 62.32 ± 37.25 ml. The urinary catheter was successfully removed 1 week after the operation, and no pelvic organ prolapse, including vaginal anterior and posterior wall prolapse, or rectocele, occurred after 3 years of follow-up.

CONCLUSION

The uterosacral ligament fulfills the role of supporting, pulling, and suspending the uterus. We should exploit the advantage of fully exposing the uterosacral ligament in radical hysterectomy. Performing HUS to prevent pelvic organ prolapse following radical hysterectomy is a procedure worthy of investigation and promotion.