Women have a 40% lifetime risk of pelvic organ prolapse, of whom 11-20% will go on to have surgery.1 There have been recent controversies regarding the use of mesh in vaginal prolapse repair. Research indicates that the use of mesh results in improved prolapse symptoms and examination findings as compared with native tissue repair. The use of mesh, however, also has significantly increased risks of mesh complications, bladder injuries, and needing repeat surgeries to address these issues, which then also have their own risks.2 Because there is no robust evidence to support the position that the benefits of mesh outweigh the risks related to their use for primary surgical prolapse repair, transvaginal mesh products for prolapse have been withdrawn from the Australian market recently. As a result, there has been a renewed interest in native tissue repair techniques.3 It must be recognized, however, that these procedures, whilst very successful in managing uterovaginal prolapse and post-hysterectomy vaginal prolapse, are not without their own limitations and complications.
This video demonstrates uterosacral ligament suspension at the time of total laparoscopic hysterectomy. Uterosacral ligament suspension is one type of native tissue repair technique for apical prolapse; it can be performed through several methods including transvaginal, abdominal, laparoscopic and robotic-assisted approaches. This presentation will review the literature regarding the use of uterosacral ligament suspension to manage pelvic organ prolapse. This presentation will also discuss the different techniques and surgical approaches, surgical considerations to this procedure, and perioperative outcomes.