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Surgical Anatomy of the Uterosacral Ligament Colpopexy

Siff, Lauren N., MD; Jallad, Karl, MD; Hickman, Lisa C., MD; Walters, Mark D., MD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p 380–382
doi: 10.1097/SPV.0000000000000461
Original Articles

Objective The aim of this study was to describe the relationship of the uterosacral ligament (USL) to the ureter and rectum along a surgeon's target location for suture placement under conditions simulating live surgery.

Methods Dissections were performed in 11 unembalmed female cadavers. Steps were taken to identify the USL simulating USL colpopexy. Pins were placed in the midportion of the USL at the level of the IS, and at 1-cm, 2-cm, and 3-cm increments traveling proximally toward the sacrum (Fig. 1). We measured minimum distances from the USL to the ureter and rectum at each target location.

Results In general, the ureters range from 1.3 to 2.0 cm lateral to the USLs along the target length. The rectum ranges from 1.9 to 2.6 cm from the right USL and remains 1.5 cm from the left USL. The mean change in distance between the ureter and USL for every 1 cm advanced toward the sacrum is 0.2 cm (95% confidence interval [CI], 0.19–0.24) on the right and 0.2 cm (95% CI, 0.18–0.27) on the left. The mean change in distance between the rectum and USL for every 1 cm advanced toward the sacrum is 0.2 cm (95% CI, 0.19–0.24) on the right and 0.0 cm (95% CI, 0–0) on the left.

Conclusions For every centimeter traveled along the bilateral USLs from the IS toward the sacrum, the ureter moves 0.2 cm laterally away from the ligament, the rectum moves 0.2 cm medially away from the right USL, but maintains its position from the left USL.

From the Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH.

Correspondence: Lauren N. Siff, MD, Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, A81 Cleveland, OH 44195. E-mail: laurensiff@gmail.com.

The authors have declared they have no conflicts of interest.

This work was presented at the 43rd annual scientific meeting of the Society for Gynecologic Surgeons in San Antonio, TX, on March 28, 2017.

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