Tips and tricks for uterosacral ligament suspension: how to avoid ureteral injury

Uterosacral ligament (USL) suspension is an effective and versatile surgical technique for repairing pelvic organ prolapse. However, ureteral injury is a feared complication that may act as a significant deterrent to the use of USL suspension. The aim of the video is to provide key steps to minimize the risk of ureteral injury while achieving successful transvaginal USL suspension. The featured video provides a series of surgical tips and tricks that can be applied to protect the ureters while achieving USL suspension whether the procedure contemplated is vaginal hysterectomy, vaginal vault repair after hysterectomy, or hysteropexy. The tips and tricks are classified into four categories: identification of the USLs, identification of the ureters, passage of the sutures, and final measures. The USL suspension technique requires adequate surgical training and an understanding of pelvic anatomy. This tips and tricks video tutorial may be an important tool for improving surgical know-how, and thus for reducing the risk of ureteral injury. In particular, identification of the USLs and ureters, proper suture positioning and final cystoscopy are key points to minimize ureteral damage.