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Uterosacral Ligament Suspension

A Radiographic Study of Suture Location in Live Subjects

Smith, Benjamin C. MD*; Herfel, Charles V. MD; Yeung, Jennifer DO*; Shatkin-Margolis, Abigail MD*; Crisp, Catrina C. MD, MSc*; Kleeman, Steven D. MD*; Pauls, Rachel N. MD*

Female Pelvic Medicine & Reconstructive Surgery: August 31, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000629
Original Article: PDF Only

Objectives This study aimed to describe uterosacral ligament suspension (USLS) suture location relative to the surrounding anatomy in a living model using computed tomographic imaging.

Methods This was an institutional review board–approved prospective descriptive study. Women aged 18 to 85 years undergoing vaginal hysterectomy with USLS were eligible. A size ‘small’ titanium vascular clip was applied to the base of each USLS suture. Computed tomography of the pelvis was performed on postoperative day 1. Preoperative and postoperative neurologic questionnaires and physical examinations were performed. A sample size of 15 subjects was deemed appropriate for this pilot study.

Results Seventeen subjects were enrolled: 2 excluded and 15 analyzed. The median (interquartile range) age of the subjects was 57 (22) years. The closest branch of the internal iliac complex was 2.6 (0.9) cm (median [interquartile range]) from the proximal suture on the right and 2.6 (0.5) cm on the left. The right ureter was 2.1 (0.7) cm from the right proximal suture. The left ureter was 2.3 (1.0) cm from the left proximal suture. The rectal lumen were 3.0 (1.6) cm from the right proximal suture and 2.8 (1.4) cm from the left proximal suture. No subjects were found to have neurologic involvement of the sutures based on neurologic questionnaire responses and physical examination.

Conclusions In live subjects, our study confirms that the vasculature, ureter, and rectum of the pelvic side wall are near suture placement for USLS. This information highlights the importance of careful dissection and awareness of anatomic landmarks.

From the *Division of Urogynecology and Pelvic Reconstructive Surgery and

Department of Radiology, TriHealth, Good Samaritan Hospital, Cincinnati, OH.

Correspondence: Benjamin C. Smith, MD, TriHealth Good Samaritan Hospital, 3219 Clifton Ave, Medical Office Bldg Suite 100, Cincinnati, OH 45220. E-mail:

This study was supported by an education grant from the TriHealth Medical Education Research Fund.

The authors have declared that there are no conflicts of interest.

This study was registered with the National Clinical Trials Registry: NCT02700997.

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