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Laparoscopic Approach for Shull Repair of Pelvic Floor Defects.

Research paper by Stefano S Restaino, Carlo C Ronsini, Angelo A Finelli, Alessandro A Santarelli, Giovanni G Scambia, Francesco F Fanfani

Indexed on: 01 Jan '18Published on: 01 Jan '18Published in: Journal of Minimally Invasive Gynecology



Abstract

Study Objective To prove the feasibility of Shull technique by a laparoscopy approach in patient affected by pelvic organ prolapse (POP) with apical loss of support. Design A step-by-step demonstration of the technique in a surgical video, including the fundamental steps for a laparoscopic uterosacral ligament suspension (USLS) (Canadian Task Force Classification III). Setting According to the National Health and Nutrition Examination Survey, approximately 3% of women in the United States report symptoms linked to POP. There are approximately 300,000 POP surgeries each year in the United States. More recent studies show a lower reoperation rate of approximately 6-30%, this lower reoperation rate may reflect improvement in surgical technique, and POP surgery that includes suspension of the vaginal apex is associated with a decreased reoperation rate, commonly done by vaginal vault suspension to uterosacral ligaments. Suturing the apex to the high (proximal) portion of each uterosacral ligaments (USL) is more commonly performed vaginally, although abdominal and laparoscopic approaches are suitable. It represents a modification of the USLS procedure described by Shull. Intervention A 53-year-old woman with a POP-Q stage IV, left ovarian cyst and a "elongatio colli" has performed a total hysterectomy and bilateral ovariectomy with vaginal dome uterosacral ligament suspension (USLS) performed by laparoscopy. The total operating time was 80 minutes, blood loss volume was mionor less 50 cc. Hospitalization stay was 2 days. There were no postoperative complications in 30 days. Conclusion Shull laparoscopic surgery for advance POP with reconstruction of the anterior compartment is technically feasible.